Automated interpretive medical care system and methodology

ABSTRACT

Improved apparatus and methods for monitoring, diagnosing and treating at least one medical respiratory condition of a patient are provided, including a medical data input interface adapted to provide at least one medical parameter relating at least to the respiration of the patient, and a medical parameter interpretation functionality ( 104, 110 ) adapted to receive the at least one medical parameter relating at least to the respiration ( 102 ) of the patient and to provide at least one output indication ( 112 ) relating to a degree of severity of at least one medical condition indicated by the at least one medical parameter.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/447,205, filed on Jul. 30, 2014, which is continuation of U.S. patentapplication Ser. No. 14/146,556, filed Jan. 2, 2014, which is acontinuation of U.S. patent application Ser. No. 12/213,619, now U.S.Pat. No. 8,679,029, filed Jun. 23, 2008, which is a continuation of U.S.patent application Ser. No. 10/433,760, now U.S. Pat. No. 8,147,419,filed Jun. 10, 2004, which is a U.S. National Phase of PCT ApplicationNo. PCT/IL2001/001127, filed Dec. 6, 2001, which claims priority to U.S.Provisional Patent Application No. 60/251,829 filed Dec. 7, 2000, andU.S. Provisional Patent Application No. 60/251,828 filed Dec. 7, 2000,the contents of which are incorporated herein by reference in theirentirety for all purposes.

FIELD OF THE INVENTION

The present invention relates to the use of respiratory information inautomated medical status assessment.

BACKGROUND OF THE INVENTION

The following U.S. Patent and publication are believed to represent thecurrent state of the art: U.S. Pat. No. 4,440,177 to Anderson et al,describes a respiratory analyzer system. Reference is also made to NIHpublication on: 97-4051 entitled “Guidelines for the Diagnosis andManagement of Asthma” pp 108-109, 1991.

The disclosures of all references mentioned above and throughout thepresent specification are hereby incorporated herein by reference.

SUMMARY OF THE INVENTION

The present invention seeks to provide improved methods and apparatusfor monitoring, diagnosing and treating at least one medical respiratorycondition.

There is thus provided in accordance with a preferred embodiment of thepresent invention, a system employing at least one parameter relating atleast to respiration of a patient for providing an indication relatingto at least one medical condition, the system including:

a medical data input interface adapted to provide the at least onemedical parameter relating at least to respiration of the patient, and

a medical parameter interpretation functionality receiving the at leastone medical parameter relating at least to respiration of the patientand providing the at least one output indication relating to a degree ofseverity of at least one medical condition indicated by the at least onemedical parameter.

There is thus also provided in accordance with another preferredembodiment of the present invention, a system employing at least oneparameter relating at least to respiration of a patient for providing atleast one indication relating to at least one medical condition, thesystem including:

-   -   a mobile platform, and    -   a medical care facility suitable for use by an operator other        than a medical doctor, the medical care facility including:        -   a medical data input interface providing the at least one            medical parameter regarding a patient, and        -   a medical parameter interpretation functionality receiving            the at least one medical parameter regarding the patient and            providing the at least one output indication relating to a            degree of severity of the at least one medical condition            indicated by the at least one medical parameter.

There is thus further provided in accordance with another preferredembodiment of the present invention, a system employing at least oneparameter relating at least to respiration of a patient for providing atleast one indication relating to at least one medical condition, thesystem including:

a medical data input interface providing the at least one medicalparameter regarding a patient,

a medical parameter interpretation functionality receiving the at leastone medical parameter regarding the patient and providing the at leastone output indication, and

a treatment control functionality for controlling the provision of atleast one treatment to a patient in response to the at least one outputindication.

There is thus further provided in accordance with yet another preferredembodiment of the present invention, a system employing at least oneparameter relating at least to respiration of a patient for providing atleast one indication relating to at least one medical condition, thesystem including:

a mobile platform, and

a medical care facility suitable for use by an operator other than amedical doctor, the medical care facility including:

-   -   a medical data input interface providing the at least one        medical parameter regarding a patient,    -   a medical parameter interpretation functionality receiving the        at least one medical parameter regarding the patient and        providing the at least one output indication, and    -   a treatment control functionality for controlling the provision        of at least one treatment to a patient in response to the at        least one output indication.

There is thus also provided in accordance with another preferredembodiment of the present invention, a system employing at least twoparameters relating at least to respiration of a patient for providingat least one indication relating to at least one medical condition, thesystem including:

a medical data input interface providing at least two medical parametersregarding a patient, and

a medical parameter interpretation functionality receiving the at leasttwo medical parameters regarding the patient and providing the at leastone output indication relating to at feast one medical conditionindicated by the at least two medical parameters.

There is thus yet further provided in accordance with another preferredembodiment of the present invention, a system employing at least twoparameters relating at least to respiration of a patient for providingat least one indication relating to at least one medical condition, thesystem including:

a mobile platform, and

a medical care facility suitable for use by an operator other than amedical doctor, the medical care facility including:

-   -   a medical data input interface providing at least two medical        parameters regarding a patient, and    -   a medical parameter interpretation functionality receiving the        at least two medical parameters regarding the patient and        providing the at least one output indication relating to at        least one medical condition indicated by the at least two        medical parameters.

There is thus also provided in accordance with another preferredembodiment of the present invention, a system employing a plurality ofparameters relating at least to respiration of a patient for providing aplurality of indications relating to at least one medical condition, thesystem including:

a medical data input interface providing the plurality of medicalparameters regarding a patient,

a medical parameter interpretation functionality receiving the pluralityof medical parameters regarding the patient and providing the pluralityof output indications, and

a medical treatment control functionality for controlling the provisionof at least one treatment to a patient in response to changes in therelationship between the output indications.

There is thus further provided in accordance with yet another preferredembodiment of the present invention, a system employing a plurality ofparameters relating at least to respiration of a patient for providing aplurality of indications relating to at least one Medical condition, thesystem including:

a mobile platform, and

a medical care facility suitable for use by an operator other than amedical doctor, the medical care facility including:

-   -   a medical data input interface providing a plurality of medical        parameters regarding a patient,    -   a medical parameter interpretation functionality receiving the        plurality of medical parameters regarding the patient and        providing the plurality of output indications, and    -   a medical treatment control functionality for controlling the        provision of at least one treatment to a patient in response to        changes in the relationship between the output indications.

There is thus further provided in accordance with another preferredembodiment of the present invention, a system employing a plurality ofparameters relating at least to respiration of a patient for providingan indication relating to at least one medical condition, the systemincluding:

a medical data input interface providing the plurality of medicalparameters regarding a patient, and

a medical parameter response functionality receiving the plurality ofmedical parameters regarding the patient and providing an outputindication based on the relationship between the medical parameters.

There is thus yet further provided in accordance with another preferredembodiment of the present invention, a system employing a plurality ofparameters relating at least to respiration of a patient for providingan indication relating to at least one medical condition, the systemincluding:

a mobile platform, and

a medical care facility suitable for use by an operator other than amedical doctor, the medical care facility including:

-   -   a medical data input interface providing the plurality of        medical parameters regarding a patient, and    -   a medical parameter response functionality receiving the        plurality of medical parameters regarding the patient and        providing an output indication based on the relationship between        the medical parameters.

There is thus additionally provided in accordance with another preferredembodiment of the present invention, a system employing a plurality ofparameters relating at least to respiration of a patient for providingan indication relating to at least one medical condition, the systemincluding:

a medical data input interface providing the plurality of medicalparameters regarding a patient, and

a medical treatment control functionality receiving the plurality ofmedical parameters regarding the patient and controlling at least onetreatment based on a relationship between the medical parameters.

There is thus further provided in accordance with another preferredembodiment of the present invention, a system employing a plurality ofparameters relating at least to respiration of a patient for providingan indication relating to at least one medical condition, the systemincluding:

a mobile platform, and

a medical care facility suitable for use by an operator other than amedical doctor, the medical care facility including:

-   -   a medical data input interface providing the plurality of        medical parameters regarding a patient, and    -   a medical treatment control functionality receiving the        plurality of medical parameters regarding the patient and        controlling at least one treatment based on a relationship        between the medical parameters.

There is thus also provided in accordance with another preferredembodiment of the present invention, a system employing a plurality ofparameters relating at least to respiration of a patient for providingan indication relating to at least one medical condition, the systemincluding:

a medical data input interface providing the plurality of medicalparameters regarding a patient, and

a medical parameter response functionality receiving the plurality ofmedical parameters regarding the patient and providing an outputindication relating to a degree of severity of at least one medicalcondition indicated by the plurality of medical parameters.

There is thus also provided in accordance with another preferredembodiment of the present invention, a system employing a plurality ofparameters relating at least to respiration of a patient for providingan indication relating to at least one medical condition, the systemincluding:

a mobile platform, and

a medical care facility suitable for use by an operator other than amedical doctor, the medical care facility including:

-   -   a medical data input interface providing the plurality of        medical parameters regarding a patient, and    -   a medical parameter response functionality receiving the        plurality of medical parameters regarding the patient and        providing an output indication relating to a degree of severity        of at least one medical condition indicated by the plurality of        medical parameters.

There is thus further provided in accordance with another preferredembodiment of the present invention, an emergency medical transportfacility including:

a mobile platform, and

a medical care system suitable for use by an operator other than amedical doctor, the medical care system including:

-   -   a medical data input interface providing at least one medical        parameter regarding a patient, and    -   a medical parameter interpretation functionality receiving the        at least one medical parameter regarding the patient and        providing an output indication relating to a degree of severity        of at least one medical condition indicated by the at least one        medical parameter.

There is thus also provided in accordance with another preferredembodiment of the present invention, a system employing at least oneparameter relating at least to respiration of a patient for providing anindication relating to at least one medical condition, the systemincluding:

a medical data input interface adapted to provide the at least onemedical parameter relating at least to respiration of the patient, and

a medical parameter interpretation functionality receiving the at leastone medical parameter regarding the patient, and wherein the at leastone medical parameter interpretation functionality includes:

a medical condition diagnosis functionality for diagnosing the presenceof the at least one medical condition, and

a medical condition severity functionality indicating the degree ofseverity of the at least one medical condition.

There is thus further provided in accordance with another preferredembodiment of the present invention, a system employing at least oneparameter relating at least to respiration of a patient for providing anindication relating to at least one medical condition, the systemincluding:

a mobile platform, and

a medical care facility suitable for use by an operator other than amedical doctor, the medical care facility including:

-   -   a medical data input interface providing the at least one        medical parameter regarding a patient, and    -   a medical parameter interpretation functionality receiving the        at least one medical parameter regarding the patient and wherein        the at least one medical parameter interpretation functionality        includes:

a medical condition diagnosis functionality for diagnosing the presenceof the at least one medical condition, and

a medical condition severity functionality indicating the degree ofseverity of the at least one medical condition.

There is thus also provided in accordance with another preferredembodiment of the present invention, a system employing at least oneparameter relating at least to respiration of a patient for providing anindication relating to at least one medical condition, the systemincluding:

a medical data input interface adapted to provide the at least onemedical parameter relating at least to respiration of the patient, and

a medical parameter interpretation functionality receiving the at leastone medical parameter regarding the patient, and wherein the at leastone medical parameter interpretation functionality includes:

-   -   a medical condition diagnosis functionality for diagnosing the        presence of the at least one medical condition, and    -   a medical condition severity functionality indicating the degree        of severity of the at least one medical condition, and,    -   a treatment control functionality for controlling the provision        of at least one treatment to the patient in response to the        degree of severity.

There is thus further provided in accordance with another preferredembodiment of the present invention, a system employing at least oneparameter relating at least to respiration of a patient for providing anindication relating to at least one medical condition, the systemincluding:

a mobile platform, and

a medical care facility suitable for use by an operator other than amedical doctor, the medical care facility including:

-   -   a medical data input interface providing the at least one        medical parameter regarding a patient, and    -   a medical parameter interpretation functionality receiving the        at least one medical parameter regarding the patient and wherein        the at least one medical parameter interpretation functionality        includes:        -   a medical condition diagnosis functionality for diagnosing            the presence of the at least one medical condition, and        -   a medical condition severity functionality indicating the            degree of severity of the at least one medical condition,            and,    -   a treatment control functionality for controlling the provision,        of at least one treatment to the patient in response to the        degree of severity.

There is thus also provided in accordance with another preferredembodiment of the present invention, an emergency medical transportmethodology including:

transporting a patient on a mobile platform,

interfacing the patient with a medical data interface which provides atleast one medical parameter of the patient, and

inputting the medical parameter to a medical parameter interpretationfunctionality, which interprets the at least one medical parameter andprovides an output indication relating to a degree of severity of the atleast one medical condition.

There is thus also provided in accordance with another preferredembodiment of the present invention, a method of determining the degreeof severity of at least one medical condition of a patient, thecondition being associated with at least one medical parameter,including the steps of:

interfacing the patient with a medical data interface which provides atleast one medical parameter of the patient, and

inputting the medical parameter to a medical parameter interpretationfunctionality, which interprets the at least one medical parameter andprovides an output indication relating to a degree of severity of the atleast one medical condition.

There is thus also provided in accordance with another preferredembodiment of the present invention, a method of controlling theprovision of at least one treatment to a patient for at least onemedical condition including the steps of:

interfacing the patient with a medical data interface which provides atleast one medical parameter of the patient,

inputting the at least one medical parameter to a medical parameterinterpretation functionality, which interprets the at least one medicalparameter and provides an output indication, and

controlling the provision of the at least one treatment in response tothe output indication.

There is thus further provided in accordance with another preferredembodiment of the present invention, a method of providing an outputindication relating to at least one medical condition indicated by atleast two medical parameters, including the steps of:

interfacing the patient with a medical data interface which provides atleast two medical parameters of the patient,

inputting the at least two medical parameters to a medical parameterinterpretation functionality, which interprets the at least two medicalparameters and provides an output indication of the at least one medicalcondition.

There is thus also provided in accordance with another preferredembodiment of the present invention, a method of controlling theprovision of at least one treatment for at least one medical conditionto a patient including the steps of:

interfacing the patient with a medical data interface which provides aplurality of medical parameters of the patient,

inputting the medical parameters to a medical parameter interpretationfunctionality, which interprets the medical parameters and provides aplurality of output indications, and

controlling the provision of the at least one treatment in response tochanges in the relationship between the output indications.

There is thus further provided in accordance with another preferredembodiment of the present invention, a method of providing an outputindication regarding the clinical state for at least one medicalcondition of a patient, including the steps of:

interfacing the patient with a medical data interface which provides aplurality of medical parameters regarding the patient, and

inputting the plurality of medical parameters to a medical parameterinterpretation functionality, which provides an output indication basedon the relationship between the medical parameters.

There is thus additionally provided in accordance with another preferredembodiment of the present invention, a method of controlling theprovision of at least one treatment to a patient for at least onemedical condition including the steps of:

interfacing the patient with a medical data interface which provides aplurality of medical parameters of the patient,

inputting the medical parameters to a medical parameter interpretationfunctionality,

interpreting the medical parameters by the medical parameterinterpretation functionality,

providing a plurality of output indications by the medical parameterinterpretation functionality, and

inputting the output indications to a medical treatment control unit,which controls the at least one treatment in response to therelationship between the medical parameters.

There is thus also provided in accordance with another preferredembodiment of the present invention, a method of providing an outputindication relating to a degree of severity of at least one medicalcondition of a patient including the steps of:

interfacing the patient with a medical data interface which provides aplurality of medical-parameters regarding the patient, and

inputting the medical parameters to a medical parameter interpretationfunctionality,

interpreting the medical parameters by the medical parameterinterpretation functionality,

providing a plurality of output indications by the medical parameterinterpretation functionality, and

inputting the output indications to a medical parameter response unitwhich provides a response relating to a degree of severity of the atleast one medical condition indicated by the plurality of medicalparameters.

There is thus also provided in accordance with another preferredembodiment of the present invention, a method of determining the degreeof severity of at least one medical condition of a patient, thecondition being associated with at least one medical parameter,including the steps of:

interfacing the patient with a medical data interface which provides atleast one medical parameter of the patient,

inputting the medical parameter to a medical parameter interpretationfunctionality, which interprets the at least one medical parameter andprovides an output indication relating to a degree of severity of the atleast one medical condition, and

medically treating the patient in accordance with the output indication.

There is thus further provided in accordance with another preferredembodiment of the present invention, a medical care methodologyemploying at least one parameter relating at least to respiration forproviding an indication relating to at least one medical condition, themethod including:

(i) monitoring the at least one parameter relating at least torespiration of a patient over a period of time by means of at least onemonitoring device so as to provide at least one monitoring output,

(ii) processing the at least one monitoring output so as to provide atleast one corresponding processing output by means of a processor,

(iii) displaying a first indication of the patient on a displayresponsive to the at least one corresponding processing output,

(iv) medically treating the patient in accordance with the indication,

(v) repeating the monitoring step (i) and processing step (ii),subsequent to the treatment so as to provide a difference in the atleast one monitoring parameter,

(vi) processing the difference in the at least one at least onemonitoring parameter so as to provide at least one correspondingprocessing output of the difference, and,

(vii) displaying a second indication of the patient on a displayresponsive to the at least one corresponding processing output of thedifference.

There is thus yet further provided in accordance with another preferredembodiment of the present invention, a method of controlling theprovision of at least one treatment to a patient for at least onemedical condition including the steps of:

interfacing the patient with a medical data interface which provides atleast one medical parameter of the patient,

inputting the at least one medical parameter to a medical parameterinterpretation functionality, which interprets the at least one medicalparameter and provides an output indication, and

controlling the provision of the at least one treatment in response tothe output indication.

There is thus also provided in accordance with another preferredembodiment of the present invention, a method of controlling theprovision of at least one treatment for at least one medical conditionto a patient including the steps of:

interfacing the patient with a medical data interface which provides aplurality of medical parameters of the patient,

inputting the medical parameters to a medical parameter interpretationfunctionality, which interprets the medical parameters and provides aplurality of output indications,

controlling the provision of the at least one treatment in response tochanges in the relationship between the output indications, and

providing an update in a status of the patient responsive to the outputindications.

There is thus further provided in accordance with another preferredembodiment of the present invention, a method of providing an outputindication regarding the clinical state for at least one medicalcondition of a patient, including the steps of:

interfacing the patient with a medical data interface which provides aplurality of medical parameters regarding the patient,

inputting the plurality of medical parameters to a medical parameterinterpretation functionality, which provides the output indication basedon the relationship between the medical parameters, and

providing a treatment recommendation by means of a treatmentrecommendation functionality.

There is thus further provided in accordance with another preferredembodiment of the present invention, a method of controlling theprovision of at least one treatment to a patient for at least onemedical condition including the steps of:

interfacing the patient with a medical data interface which provides aplurality of medical parameters of the patient,

inputting the medical parameters to a medical parameter interpretationfunctionality, which interprets the medical parameters and provides aplurality of output indications,

inputting the output indications to a medical treatment control unit,which controls the at least one treatment in response to therelationship between the medical parameters, and

providing an update in a status of the patient responsive to therelationship between the medical parameters.

There is thus yet further provided in accordance with another preferredembodiment of the present invention, a method of providing an outputindication relating to a degree of severity of at least one medicalcondition of a patient including the steps of:

interfacing the patient with a medical data interface which provides aplurality of medical parameters regarding the patient, and

inputting the medical parameters to a medical parameter interpretationfunctionality, which interprets the medical parameters and provides aplurality of output indications,

inputting the output indications to a medical parameter response unitwhich provides a response relating to a degree of severity of the atleast one medical condition indicated by the plurality of medicalparameters, and

controlling the provision of at least one treatment in response to thedegree of severity.

There is thus also provided in accordance with another preferredembodiment of the present invention, a computer software product fordetermining the degree of severity of at least one medical condition ofa patient, the condition being associated with at least one medicalparameter, including a computer-readable medium in which programinstructions are stored, which instructions, when read by a computer,cause the computer to:

interface the patient with a medical data interface which provides atleast one medical parameter of the patient, and

input the medical parameter to a medical parameter interpretationfunctionality, which interprets the at least one medical parameter andprovides an output indication relating to a degree of severity of the atleast one medical condition.

There is thus further provided in accordance with another preferredembodiment of the present invention, a computer software product forcontrolling the provision of at least one treatment to a patientincluding a computer-readable medium in which program instructions arestored, which instructions, when read by a computer, cause the computerto:

interface the patient with a medical data interface which provides atleast one medical parameter of the patient,

input the medical parameter to a medical parameter interpretationfunctionality, which interprets the at least one medical parameter andprovides an output indication, and

control the provision of the at least one treatment in response to theoutput indication.

There is thus further provided in accordance with another preferredembodiment of the present invention, a computer software product forproviding an output indication relating to at least one medicalcondition of a patient indicated by at least two medical parameters,including a computer-readable medium in which program instructions arestored, which instructions, when read by a computer, cause the computerto:

interface the patient with a medical data interface which provides atleast two medical parameters of the patient,

input the at least two medical parameters to a medical parameterinterpretation functionality, which interprets the at least two medicalparameters and provides an output indication of the at least one medicalcondition.

There is thus further provided in accordance with another preferredembodiment of the present invention, a computer software product forcontrolling the provision of at least one treatment to a patient,including a computer-readable medium in which program instructions arestored, which instructions, when read by a computer, cause the computerto:

interface the patient with a medical data interface which provides aplurality of medical parameters of the patient,

input the medical parameters to a medical parameter interpretationfunctionality, which interprets the medical parameters and provides aplurality of output indications, and

control the provision of the at least one treatment in response tochanges in the relationship between the output indications.

There is thus also provided in accordance with another preferredembodiment of the present invention, a computer software product forproviding an output indication regarding the clinical state of apatient, including a computer-readable medium in which programinstructions are stored, which instructions, when read by a computer,cause the computer to:

interface the patient with a medical data interface which provides aplurality of medical parameters regarding the patient, and

input the medical parameters to a medical parameter response unit, whichproviding the output indication based on the relationship between themedical parameters.

There is thus further provided in accordance with another preferredembodiment of the present invention, a computer software product forcontrolling the provision of at least one treatment to a patient,including a computer-readable medium in which program instructions arestored, which instructions, when read by a computer, cause the computerto:

interface the patient with a medical data interface which provides aplurality of medical parameters of the patient,

input the medical parameters to a medical treatment control unit, whichcontrols the at least one treatment in response to the relationshipbetween the medical parameters.

There is thus additionally provided in accordance with another preferredembodiment of the present invention, a computer software product forproviding an output indication relating to a degree of severity of atleast one medical condition of a patient including a computer-readablemedium in which program instructions are stored, which instructions,when read by a computer, cause the computer to:

interface the patient with a medical data interface which provides aplurality of medical parameters regarding the patient, and

input the medical parameters to a medical parameter response unit whichprovides an output indication relating to a degree of severity of the atleast one medical condition indicated by the plurality of medicalparameters.

There is thus also provided in accordance with another preferredembodiment of the present invention, a computer software product forrelating at least to respiration of a patient for providing anindication relating to at least one medical condition, including acomputer-readable medium in which program instructions are stored, whichinstructions, when read by a computer, cause the computer to:

provide the at least one medical parameter relating at least torespiration of the patient by means of a medical data input interface,and

receive the at least one medical parameter regarding the patient bymeans of a medical parameter interpretation functionality, and,

provide an output indication relating to a degree of severity of atleast one medical condition indicated by the at least one medicalparameter.

There is thus also provided in accordance with another preferredembodiment of the present invention, a computer software product forproviding an indication relating to at least one medical condition,including a computer-readable medium in which program instructions arestored, which instructions, when read by a computer, cause the computerto:

(i) monitor at least one parameter relating at least to respiration of apatient over a period of time by means of at least one monitoring deviceso as to provide at least one monitoring output,

(ii) process the at least one monitoring output so as to provide atleast one corresponding processing output by means of a processor,

(iii) display a first indication of the patient on a display responsiveto the at least one corresponding processing output,

(iv) medical treating the patient in accordance with the indication,

(v) repeat the monitoring step (i) and processing step (ii), subsequentto the treatment so as to provide a difference in the at least onemonitoring parameter,

(vi) process the difference in the at least one at least one monitoringparameter so as to provide at least one corresponding processing outputof the difference, and,

(vii) display a second indication of the patient on a display responsiveto the at least one corresponding processing output of the difference.

There is thus also provided in accordance with another preferredembodiment of the present invention, a computer software product forcontrolling the provision of at least one treatment to a patient for atleast one medical condition including a computer-readable medium inwhich program instructions are stored, which instructions, when read bya computer, cause the computer to:

interface the patient with a medical data interface which provides atleast one medical parameter of the patient,

input the at least one medical parameter to a medical parameterinterpretation functionality, which interprets the at least one medicalparameter and provides an output indication, and

control the provision of the at least one treatment in response to theoutput indication.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the data input interfaceincludes at least one monitoring device operative to continuouslymonitor the at least one medical parameter.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the data input interfaceincludes at least one monitoring device operative to continuouslymonitor the at least two medical parameters.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the data input interfaceincludes at least one monitoring device operative to continuouslymonitor the plurality of medical parameters.

Preferably, the at least one monitoring device includes a capnograph.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least onemonitoring device is operative to collect a sample of expired air fromthe patient.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least onemonitoring device includes at least one of the following:

an electrocardiogram (ECG) monitoring device,

a blood pressure monitoring device,

an electroencephalogram (EEG) monitoring device,

an NI blood pressure monitoring device,

a respiratory rate monitoring device,

a heart rate monitoring device,

a systemic perfusion monitoring device, and

an exhaled air monitoring device.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least onemonitoring device is operative to monitor at least one of:

an expired air carbon dioxide concentration, and

an expired air carbon dioxide profile parameter.

Yet further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least onemonitoring device is operative to monitor at least one of the followingwaveforms:

a carbon dioxide waveform (capnogram),

an EEG waveform, and

an ECG waveform.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least onemonitoring device is adapted to digitize at least one of the waveforms.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein at least one of:

the at least one monitoring device, and

the medical parameter interpretation functionality, is further operativeto provide at least one of the following measurements:

a slope of the increase in the carbon dioxide concentration,

a run of time taken to reach 80% maximum exhaled CO₂ concentration, and

an angle of rise to 80% maximum exhaled CO₂ concentration.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein at least one of:

the at least one monitoring device, and

the medical parameter interpretation functionality, is further operativeto a value of CAP-FEV1.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is further operative to provide an alertresponsive to a measure of CAP-FEV1 being less than 50% of an expectedvalue.

Moreover, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is further operative to provide an alertresponsive to the run being greater than 0.3 seconds and the slope beingless than 100 mm Hg/sec.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is further operative to provide anindication of at least one of:

defective functioning of the monitoring device, and,

defective placing of the monitoring device,

responsive to a value of at least one of the measurements.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least one medicalparameter includes at least one of:

an expired air carbon dioxide concentration, and

an expired air carbon dioxide profile parameter.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least one medicalparameter includes at least one of:

a visual parameter,

a breathing parameter,

an oxygen parameter,

an ECG parameter,

a heart function parameter,

a neurological parameter,

a blood pressure parameter, and

an EEG parameter.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least two medicalparameters include at least one of:

a visual parameter,

a breathing parameter,

an oxygen parameter,

an ECG parameter,

a heart function parameter,

a neurological parameter,

a blood pressure parameter, and

an EEG parameter.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the plurality of medicalparameters includes at least one of:

a visual parameter,

a breathing parameter,

an oxygen parameter,

an ECG parameter,

a heart function parameter,

a neurological parameter,

a blood pressure parameter, and

an EEG parameter.

Also, the visual parameter includes a visual appearance of the patient.

Additionally, the breathing parameter includes at least one of:

a respiratory rate of the patient,

an FEV value, and

an FVC value.

Furthermore, the oxygen parameter includes at least one of:

PO₂, and

SPO₂

Preferably, the ECG parameter includes at least one of:

a QRS parameter, and

an ST segment.

Typically, the heart function parameter includes a heart rate parameter.

Generally, the neurological function parameter includes a reflexparameter.

Also, the blood pressure parameter includes at least one of:

a blood pressure measurement, and

a systolic:diastolic ratio.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is operative to provide an indication ofthe patient's status being within a normal range if at least one of thefollowing requirements is fulfilled:

a) the blood pressure values are within the normal range,

b) the respiratory rate is normal,

c) CO₂ run is less than or equal to 0.3 sec,

d) CO₂ slope is more than or equal to 100 mm Hg/sec,

e) SPO₂ is greater or equal to than 95%, and

f) ETCO₂ is less than or equal to 45 mm Hg.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterresponse functionality is operative to provide an output indicationresponsive to a deviation from any one of the following requirements:

a) the blood pressure values are within the normal range,

b) the respiratory rate is normal,

c) CO₂ run is less than or equal to 0.3 sec,

d) CO₂ slope is more than or equal to 100 mm Hg/sec,

e) SPO₂ is greater or equal to than 95%, and

f) ETCO₂ is less than or equal to 45 mm Hg.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical treatmentcontrol functionality is operative to provide a treatment to the patientresponsive to a deviation from any one of these requirements:

a) the blood pressure values are within the normal range,

b) the respiratory rate is normal,

c) CO₂ run is less than or equal to 0.3 sec,

d) CO₂ slope is more than or equal to 100 mm Hg/sec,

e) SPO₂ is greater or equal to than 95%, and

f) ETCO₂ is less than or equal to 45 mm Hg.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is operative to provide an indication ofthe patient's status being within a normal range if all of the followingrequirements are fulfilled:

a) the blood pressure values are within the normal range,

b) the respiratory rate is normal,

c) CO₂ run is less than or equal to 0.3 sec,

d) CO₂ slope is more than or equal to 100 mm Hg/sec,

e) SPO₂ is greater or equal to than 95%, and

f) ETCO₂ is less than or equal to 45 mm Hg.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality includes:

a medical condition diagnosis functionality for diagnosing the presenceof the at least one medical condition, and

a medical condition severity indication functionality for indicating thedegree of severity of the at least one medical condition.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is operative to provide an indication ofthe patient's status being outside the normal range if any of therequirements are not fulfilled.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical conditionseverity functionality is operative to provide an indication of thedegree of severity of the at least one medical condition responsive to adegree of deviation of from at least one of the requirements.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical conditiondiagnosis functionality is operative to diagnose a respiratory disorder.

Moreover, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical conditiondiagnosis functionality is further operative to provide a diagnosis of arespiratory disorder responsive to any of the requirements not beingfulfilled.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical conditiondiagnosis functionality is further operative to provide a diagnosis of aseverity of the respiratory disorder responsive to a quantitativemeasure of deviation of at least one parameter from at least one of therequirements.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the respiratory disorderincludes at least one of:

a restrictive lung disease,

bronchospasm,

asthma,

bronchitis;

emphysema,

a respiratory failure,

fibrosis, and

an upper airway obstructive disease.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical conditiondiagnosis functionality is operative to provide a diagnosis of therestrictive lung disease responsive to at least one of the followingcases:

the run is greater or equal to 0.3 sec, or

the slope is less than or equal to 100 mm Hg/sec.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical conditiondiagnosis functionality is operative to provide a diagnosis of theobstructive lung disease responsive to at least one of the followingcases:

the run is less than 0.3 sec, or

the slope is more than 100 mm Hg/sec.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical conditiondiagnosis functionality is further operative to provide a diagnosis of aheart disorder responsive to any of the requirements not beingfulfilled.

Yet further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical conditiondiagnosis functionality is further operative to provide a diagnosis of aheart failure if the following requirements are fulfilled:

CAP-FEV1 is less than or equal to a 40:10 point ratio,

a normal CAP-FEV1/FVC ratio,

CO₂ run is less than 0.3 sec, and

CO₂ slope is more than 100 mm Hg/sec.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical conditiondiagnosis functionality is further operative to provide a diagnosis of aseverity of the heart disorder responsive to a quantitative measure of adeviation from any of the requirements.

Moreover, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is operative to provide a recommendation toperform at least one of the following treatments responsive to theindication:

intubation of the patient,

hospitalization of the patient,

treat the patient with medication, and

transfer of the patient to an intensive care unit.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is operative to provide the at least oneoutput indication responsive to a pattern of changes in the at least onemedical parameter over time.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is further operative to provide an outputindication responsive to a pattern of changes in the degree of severityof the at least one medical condition over time.

Yet further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is operative to provide the plurality ofoutput indications responsive to a pattern of changes in the pluralityof medical parameters over time.

Still further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the medical parameterinterpretation functionality is further operative to provide theplurality of output indications responsive to a pattern of changes inthe degree of severity of the at least one medical condition over time.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system which also includes a treatmentrecommendation functionality.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is operative to recommend treatmentresponsive to the location of the patient.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is operative to recommend treatmentresponsive to a change in at least one of the following:

a change in the run,

a change in the ETCO₂,

a change in the slope,

a change in the angle of rise of CO₂, and

a change in the SPO₂.

Yet further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is responsive to a pattern of changes inthe degree of severity of the at least one medical condition over time.

Still further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is operative to provide an alert if atleast one of the following requirements is fulfilled:

a change in the run of more than 0.1 s,

a change in the slope is more negative than −15 mm Hg/sec, and

a change in the SPO₂ is more negative than −5%.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is operative to provide a recommendationfor at least one of the following treatments responsive to at least oneof the requirements:

intubation of the patient,

hospitalization of the patient,

treat the patient with intravenous medication, and

transfer of the patient to an intensive care unit.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is operative to provide a recommendation toperform at least one of:

continue monitoring, and

continue treating the patient if at least one of the followingconditions is fulfilled:

-   -   a change in the run is less negative or equal to −0.1 s but less        positive or equal to 0.1 s,        -   a change in the slope is less negative or equal to −15            Hg/sec, but less positive or equal to +15 mm Hg/sec, and    -   a change in the SPO₂ is less negative or equal to −5%, but less        positive or equal to +5%.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is operative to perform at least one of thefollowing:

provide a message indicative of an improvement in the patient's status,and

recommend discontinuing a treatment procedure, if at least one of thefollowing conditions is fulfilled:

-   -   a change in the run is more negative than −0.1 s,    -   a change in the slope is more positive than +15 mm Hg/sec, and    -   a change in the SPO₂ is more positive than 5%.

Also, in accordance with a preferred embodiment, of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is operative to provide a recommendation tocontinue monitoring the patient responsive to the pattern of changesindicating at least one of:

a deterioration in the status of the patient, and,

a non-significant change in the status of the patient.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is operative to provide a recommendation tostop monitoring the patient responsive to a pattern of changesindicating an improvement in the status of the patient.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatmentrecommendation functionality is additionally responsive to informationregarding other treatment received by the patient.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system including a treatment controlfunctionality for controlling the provision of at least one treatment toa patient.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least one treatmentincludes at least one of:

intubation of the patient,

hospitalization of the patient,

treat the patient with medication, and

transfer of the patient to an intensive care unit.

Yet further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatment controlfunctionality is responsive to a pattern of changes in the at least onemedical parameter overtime.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatment controlfunctionality is responsive to a pattern of changes in the degree ofseverity of the at least one medical condition over time.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatment controlfunctionality is additionally responsive to information regarding othertreatment received by the patient.

Still further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the treatment controlfunctionality controls the provision of the at least one treatment tothe patient in response to changes in the at least output indicationover time.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least one medicalparameter includes a plurality of medical parameters.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein at least two medicalparameters include a plurality of medical parameters.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the plurality of medicalparameters includes at least two of CO₂, ECG, SPO₂, PO₂, NIBP andspirometry parameters.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the output indicationrelating to a degree of severity of at least one medical condition isdetermined at least partially by changes in the at least one medicalparameter.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a system wherein the at least one medicalparameter includes a plurality of medical parameters.

Also, the at least one medical parameter preferably includes a pluralityof medical parameters.

Yet further, in accordance with a preferred embodiment of the presentinvention, there is provided a system and also including a transmitterfunctionality adapted to convey the output indication to a remotelocation.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a system further operative to provide atreatment responsive to at least one of:

the output indication, and

the remote location.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facility andwherein the medical parameter interpretation functionality includes:

a medical condition diagnosis functionality for diagnosing the presenceof the at least one medical condition, and

a medical condition severity functionality indicating the degree ofseverity of the at least one medical condition.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the medical parameter interpretation functionality provides anoutput indication responsive to a pattern of changes in the at least onemedical parameter over time.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the medical parameter interpretation functionality provides anoutput indication responsive to a pattern of changes in the degree ofseverity of the at least one medical condition over time.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilityalso including treatment recommendation functionality.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the treatment recommendation functionality is responsive to apattern of changes in the at least one medical parameter over time.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the treatment recommendation functionality is responsive to apattern of changes in the degree of severity of the at least one medicalcondition over time.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the treatment recommendation functionality is additionallyresponsive to information regarding other treatment received by thepatient.

Moreover, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywhich includes a treatment control functionality for controlling theprovision of at least one treatment to a patient.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the treatment control functionality is responsive to a patternof changes in the at least one medical parameter over time.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the treatment control functionality is responsive to a patternof changes in the degree of severity of the at least one medicalcondition over time.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the treatment control functionality is additionally responsiveto information regarding other treatment received by the patient.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the at least one medical parameter includes a plurality ofmedical parameters.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the plurality of medical parameters includes at least two ofCO₂, ECG, SPO₂, PO₂, NIBP, EEG and spirometry parameters.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the output indication relating to a degree of severity of atleast one medical condition is determined at least partially by changesin at least one medical parameter.

Yet further, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywhich also includes a transmitter functionality for conveying the outputindication to a remote location.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport facilitywherein the treatment control functionality controls the provision ofthe at least one treatment to a patient in response to changes in theoutput indication over time.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the at least one medicalparameter includes at least one of:

an expired air carbon dioxide concentration, and

an expired air carbon dioxide profile parameter.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the at least two medicalparameters include at least one of:

an expired air carbon dioxide concentration, and

an expired air carbon dioxide profile parameter.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the plurality ofparameters includes at least one of:

an expired air carbon dioxide concentration, and

an expired air carbon dioxide profile parameter.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein interfacing the patientincludes monitoring the patient by means of at least one of:

a monitoring device, and

the medical parameter interpretation functionality.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein monitoring the patientincludes monitoring by means of at least one of the following:

an electrocardiogram (ECG) monitoring device,

a blood pressure monitoring device,

an electroencephalogram (EEG) monitoring device,

an NI blood pressure monitoring device,

a respiratory rate monitoring device,

a heart rate monitoring device,

a methodic perfusion monitoring device, and

an exhaled air monitoring device.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein monitoring includesmonitoring at least one of the following waveforms:

a carbon dioxide waveform (capnogram),

an EEG waveform, and

an ECG waveform.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the monitoring includesanalyzing a sample of expired air from the patient by a capnograph.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein analyzing the sampleincludes digitizing at least one of the waveforms.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein monitoring the patientincludes providing at least one of the following measurements:

a slope of the increase in the carbon dioxide concentration,

a run of time taken to reach 80% maximum exhaled CO₂ concentration, and

an angle of rise to 80% maximum exhaled CO₂ concentration.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the outputincludes indicating at least one of:

defective functioning of the monitoring device, and,

defective placing of the monitoring device,

responsive to a value of at least one of the measurements.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein monitoring the patientincludes providing a value of CAP-FEV1.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method including providing an alertresponsive to a measure of CAP-FEV1 being less than 50% of an expectedvalue.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein analyzing the sampleincludes providing responsive to at least one of:

the run being greater than 0.3 seconds, or

the slope being less than 100 mm Hg/sec.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the at least one medicalparameter includes at least one of:

a visual parameter,

a breathing parameter,

an oxygen parameter,

an ECG parameter,

a heart function parameter,

a neurological parameter,

a blood pressure parameter, and

an EEG parameter.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the at least two medicalparameters include at least one of:

a visual parameter,

a breathing parameter,

an oxygen parameter,

an ECG parameter,

a heart function parameter,

a neurological parameter,

a blood pressure parameter, and

an EEG parameter.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the plurality of medicalparameters include at least one of:

a visual parameter,

a breathing parameter,

an oxygen parameter,

an ECG parameter,

a heart function parameter,

a neurological parameter,

a blood pressure parameter, and

an EEG parameter.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method further including providing anindication of a status of the patient as being within a normal range ifat least one of the following requirements is fulfilled:

a) the blood pressure values are within the normal range,

b) the respiratory rate is normal,

c) CO₂ run is less than or equal to 0.3 sec,

d) CO₂ slope is more than or equal to 100 mm Hg/sec,

e) SPO₂ is greater or equal to than 95%, and

ETCO₂ is less than or equal to 45 mm Hg.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the indicationof the patient's status being within the normal range if all of thefollowing requirements are fulfilled:

a) the blood pressure values are within the normal range,

b) the respiratory rate is normal,

c) CO₂ run is less than or equal to 0.3 sec,

d) CO₂ slope is more than or equal to 100 mm Hg/sec,

e) SPO₂ is greater or equal to than 95%, and

f) ETCO₂ is less than or equal to 45 mm Hg.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a method including:

diagnosing a presence of the at least one medical condition by a medicalcondition diagnosis functionality, and

indicating a degree of severity of the at least one medical condition bya medical condition severity indication functionality.

Yet further, in accordance with a preferred embodiment of the presentinvention, there is provided a method including providing an indicationof the patient's status being outside the normal range if any of therequirements are not fulfilled.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein including indicating thedegree of severity of the at least one medical condition responsive to adegree of deviation from of any of the requirements.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein diagnosing the presence ofthe at least one medical condition includes diagnosing a respiratorydisorder.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein diagnosing the respiratorydisorder includes providing a diagnosis of a severity of the respiratorydisorder responsive to a quantitative measure of deviation from at leastone of the requirements.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the respiratory disorderincludes at least one of:

a restrictive lung disease,

bronchospasm,

asthma,

bronchitis,

emphysema,

a respiratory failure,

fibrosis, and

an upper airway obstructive disease.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein indicating the degree ofseverity includes providing a diagnosis of the restrictive lung diseaseresponsive to at least one of the following cases:

the run is greater than 0.3 sec, or

the slope is less than 100 mm Hg/sec.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein indicating the degree ofseverity includes providing a diagnosis of the obstructive lung diseaseresponsive to at least one of the following cases:

the run is less than or equal to 0.3 sec, or

the slope is more than or equal to 100 mm Hg/sec.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the indicationincludes providing a diagnosis of a heart disorder responsive to any ofthe requirements not being fulfilled.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method including providing a diagnosis ofa heart failure if the following conditions are fulfilled:

CAP-FEV1 is less than or equal to a 40:10 point ratio,

a normal CAP-FEV1/FVC ratio,

CO₂ run is less than or equal to 0.3 sec, and

CO₂ slope is more than or equal to 100 mm Hg/sec.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing an indicationincludes providing a diagnosis of a severity of the heart disorder.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing an outputindication includes providing a plurality of output indications.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing a plurality ofoutput indications includes providing at least one recommendation toperform at least one of the following treatments:

intubation of the patient,

hospitalization of the patient,

treat the patient with medication, and

transfer of the patient to an intensive care unit.

Typically the visual parameter includes a visual appearance of thepatient. Generally the breathing parameter includes at least one of:

a respiratory rate of the patient,

an FEV value, and

an FVC value.

Normally, the oxygen parameter includes at least one of:

PO₂, and

SPO₂.

Generally, the ECG parameter includes at least one of:

a QRS parameter, and

an ST segment.

Preferably, the heart function parameter includes a heart rateparameter. Typically, the neurological function parameter includes areflex parameter.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the blood pressureparameter includes at least one of:

a blood pressure measurement, and

a systolic:diastolic ratio.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a method including providing the outputindication responsive to a pattern of changes in the at least onemedical parameter over time.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the output indication isresponsive to a pattern of changes in the at least two medicalparameters over time.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method providing the output indicationresponsive to a pattern of changes in the plurality of medicalparameters over time.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method including providing an outputindication responsive to a pattern of changes in the degree of severityof the at least one medical condition over time.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a method including providing a treatmentrecommendation by means of a treatment recommendation functionality.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the treatmentrecommendation is responsive to a pattern of changes of at least onemedical parameter over time.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the treatmentrecommendation is responsive to the location of the patient.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the pattern of changesincludes a change in at least one of the following:

a change in a run,

a change in an ETCO₂,

a change in a slope,

a change in an angle of rise of CO₂, and

a change in an SPO₂.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the treatmentrecommendation is responsive to a pattern of changes in the degree ofseverity of the at least one medical condition over time.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the treatmentrecommendation includes providing an alert if at least one of thefollowing conditions is fulfilled:

a change in the run of more than 0.1 s,

a change in the slope is more negative than −15 mm Hg/sec, and

a change in the SPO₂ is more negative than −5%.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the treatmentrecommendation includes providing a recommendation for at least one ofthe following treatments:

intubation of the patient,

hospitalization of the patient,

treat the patient with intravenous medication, and

transfer of the patient to an intensive care unit.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the treatmentincludes providing a recommendation to perform at least one of:

continue monitoring the patient, and

continue treating the patient,

provided at least one of the following conditions is fulfilled:

-   -   a change in the run is less negative or equal to −0.1 s but less        positive or equal to 0.1 s,    -   a change in the slope is less negative or equal to −15, Hg/sec,        but less positive or equal to +15 mm Hg/sec, and    -   a change in the SPO₂ is less negative or equal to −5%, but less        positive or equal to +5%.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the treatmentincludes at least one of the following:

providing a message indicative of an improvement in the patient'sstatus, and

recommending discontinuing a treatment procedure, if at least one of thefollowing conditions is fulfilled:

a change in the run is more negative than −0.1 s,

a change in the slope is more positive than +15 mm Hg/sec, and

a change in the SPO₂ is more positive than 5%.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the treatmentincludes providing a recommendation to continue monitoring the patientresponsive to the pattern of changes indicating at least one of:

a deterioration in the status of the patient, and,

a non-significant change in the status of the patient.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein providing the treatmentincludes providing a recommendation to stop monitoring the patientresponsive to the pattern of changes indicating an improvement in thestatus of the patient.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method including providing at least oneof the following treatments to the patient:

intubation of the patient,

hospitalization of the patient,

treat the patient with medication, and

transfer of the patient to an intensive care unit.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein controlling the provisionof at least one treatment includes responding to a pattern of changes inthe degree of severity of the at least one medical condition over time.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the treatment controlfunctionality is additionally responds to information regarding othertreatment received by the patient.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the at least one medicalparameter includes a plurality of parameters.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the at least two medicalparameters include a plurality of parameters.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the plurality of medicalparameters includes at least two of CO₂, ECG, SPO₂, PO₂, NIBP andspirometry parameters.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the output indicationrelating to the degree of severity of the at least one medical conditionis determined at least partially by changes in the at least one medicalparameter.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided a method including conveying the outputindication to a remote location by means of a transmitter functionality.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method including conveying the pluralityof output indications to a remote location by means of a transmitterfunctionality.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided a method wherein the treatment controlfunctionality controls the provision of the at least one treatment to apatient in response to changes in the output indication over time.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein interpreting the at least one medical parameter includes:

diagnosing the presence of at least one medical condition by means of amedical condition diagnosis functionality, and

indicating the degree of severity of the at least one medical conditionby means of a medical condition severity functionality.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologyincluding providing an output indication responsive to a pattern ofchanges in the at least one medical parameter over time by means of themedical parameter interpretation functionality.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologyincluding providing an output indication responsive to a pattern ofchanges in the degree of severity of the at least one medical conditionover time.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologyincluding providing a treatment recommendation by means of a treatmentrecommendation functionality.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the treatment recommendation functionality is responsive to apattern of changes in the at least one medical parameter over time.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the treatment recommendation functionality is responsive to apattern of changes in the degree of severity of the at least one medicalcondition over time.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the treatment recommendation functionality is additionallyresponsive to information regarding other treatment received by thepatient.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein including treatment control functionality for controlling theprovision of at least one treatment to the patient.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the treatment control functionality is responsive to a patternof changes in the at least one medical parameter over time.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the treatment control functionality is responsive to a patternof changes in the degree of severity of the at least one medicalcondition over time.

Furthermore, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the treatment control functionality is additionally responsiveto information regarding other treatment received by the patient.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the at least one medical parameter includes a plurality ofmedical parameters.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the plurality of medical parameters includes at least two ofCO₂, ECG, SPO₂, PO₂, NIBP, EEG and spirometry parameters.

Further, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the output indication relating to a degree of severity of atleast one medical condition is determined at least partially by changesin at least one medical parameter.

Yet further, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologyincluding a transmitter functionality for conveying the outputindication to a remote location.

Also, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the treatment control functionality controls the provision ofthe at least one treatment to a patient in response to changes in theoutput indication over time.

Additionally, in accordance with a preferred embodiment of the presentinvention, there is provided an emergency medical transport methodologywherein the treatment control functionality controls the provision ofthe at least one treatment to a patient in response to the location ofthe patient.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood and appreciated more fully fromthe following detailed description, taken in conjunction with thedrawings in which:

FIGS. 1A, 1B and 1C are simplified pictorial illustrations showing amedical care system and methodology employing at least one parameterrelating at least to respiration for automatically providing an outputindication relating to at least one medical condition in accordance witha preferred embodiment of the present invention in three different typesof care environments;

FIG. 2 is a flowchart illustrating operation of the embodiments of FIGS.1A-1C;

FIG. 3 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology in an on-sceneenvironment for detecting the presence and severity of bronchospasm,gauging the response to treatment and recommending disposition of aspontaneously breathing patient;

FIG. 4 is a flowchart illustrating operation of the embodiment of FIG.3;

FIG. 5 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology in an on-sceneenvironment for detecting the presence and severity of bronchospasm,gauging the response to treatment and recommending disposition ofmechanically ventilated patients;

FIGS. 6A and 6B are flowcharts illustrating operation of the embodimentof FIG. 5;

FIG. 7 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology in an ambulanceenvironment for detecting the presence and severity of bronchospasm,gauging the response to treatment and recommending disposition ofspontaneously breathing patients;

FIGS. 8A and 8B are flowcharts illustrating operation of the embodimentof FIG. 7;

FIG. 9 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology in an ambulanceenvironment for detecting the presence and severity of bronchospasm,gauging the response to treatment and recommending disposition ofmechanically ventilated patients;

FIGS. 10A, 10B and 10C are a flowcharts illustrating operation of theembodiment of FIG. 9;

FIG. 11 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology in an ambulanceenvironment for detecting the severity of bronchospasm, gauging theresponse to treatment and recommending disposition of spontaneouslybreathing patients;

FIG. 12 is a flowchart illustrating operation of the embodiment of FIG.11;

FIG. 13 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology in an ambulanceenvironment for detecting the presence and severity of bronchospasm,gauging the response to treatment and recommending disposition ofmechanically ventilated patients;

FIGS. 14A and 14B are flowcharts illustrating operation of theembodiment of FIG. 13;

FIG. 15 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for distinguishing between heart failure and emphysema,where emphysema is present;

FIGS. 16A and 16B are flowcharts illustrating operation of theembodiment of FIG. 15;

FIG. 17 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for monitoring intubation status of a patient;

FIG. 18 is a flowchart illustrating operation of the embodiment of FIG.17;

FIG. 19 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for monitoring respiratory status of a patient in a firstclinical scenario;

FIG. 20 is a flowchart illustrating operation of the embodiment of FIG.19;

FIGS. 21A and 21B are simplified pictorial illustrations of an automaticmedical diagnostic and treatment system and methodology operative in ahospital environment for monitoring intubation status of a patient in asecond clinical scenario;

FIGS. 22A, 22B and 22C are flowcharts illustrating operation of theembodiment of FIGS. 21A and 21B;

FIGS. 23A and 23B are simplified pictorial illustrations of a diagnosticand treatment system and methodology operative in a physician's officeenvironment for detecting the presence and severity of bronchospasm,gauging the response to treatment and recommending disposition of aspontaneously breathing patient in a first clinical scenario;

FIGS. 24A and 24B are flowcharts illustrating operation of theembodiment of FIGS. 23A and 23B;

FIGS. 25A and 25B are simplified pictorial illustrations of an automaticmedical diagnostic and treatment system and methodology operative in aphysician's office environment for detecting the presence and severityof bronchospasm, gauging the response to treatment and recommendingdisposition of a spontaneously breathing patient in a second clinicalscenario;

FIGS. 26A and 26B are flowcharts illustrating operation of theembodiment of FIGS. 25A and 25B;

FIGS. 27A and 27B are simplified pictorial illustrations of an automaticmedical diagnostic and treatment system and methodology in an ambulanceenvironment for detecting the presence and severity of bronchospasm froman allergic reaction, gauging the response to treatment and recommendingdisposition;

FIG. 28 is a flowchart illustrating operation of the embodiment of FIGS.27A and 27B;

FIG. 29 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology in an ambulanceenvironment for distinguishing between upper airway obstruction andlower airway obstruction, gauging the response to treatment andrecommending disposition;

FIG. 30 is a flowchart illustrating operation of the embodiment of FIG.29;

FIG. 31 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for distinguishing between heart failure and emphysema in ascenario in which heart failure is present;

FIGS. 32A and 32B are flowcharts illustrating operation of theembodiment of FIG. 31;

FIG. 33 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for treating pulmonary edema;

FIGS. 34A and 34B are flowcharts illustrating operation of theembodiment of FIG. 33;

FIG. 35 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for anesthesia monitoring;

FIG. 36 is a flowchart illustrating operation of the embodiment of FIG.35;

FIG. 37 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for diagnosis and treatment of pulmonary embolism;

FIG. 38 is a flowchart illustrating operation of the embodiment of FIG.37;

FIGS. 39A and 39B are simplified pictorial illustrations of an automaticmedical diagnostic and treatment system and methodology operative in ahospital environment for determination of correct nasogastric tubeplacement;

FIG. 40 is a flowchart illustrating operation of the embodiment of FIGS.39A and 39B;

FIG. 41 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for diagnosis and treatment of myocardial infarction;

FIG. 42 is a flowchart illustrating operation of the embodiment of FIG.41;

FIG. 43 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for diagnosis and treatment of cardiogenic shock;

FIG. 44 is a flowchart illustrating operation of the embodiment of FIG.43;

FIG. 45 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for diagnosis and treatment of cardiac arrest;

FIG. 46 is a flowchart illustrating operation of the embodiment of FIG.45;

FIG. 47 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for diagnosis and treatment of cardiac ischemia;

FIG. 48 is a flowchart illustrating operation of the embodiment of FIG.47;

FIG. 49 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for monitoring sedation; and

FIG. 50 is a flowchart illustrating operation of the embodiment of FIG.49;

FIG. 51 is a simplified pictorial illustration of an automatic medicaldiagnostic and treatment system and methodology operative in a hospitalenvironment for drug titration during sedation; and

FIG. 52 is a flowchart illustrating operation of the embodiment of FIG.51.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Reference is now made to FIGS. 1A, 1B and 1C, which are simplifiedpictorial illustrations showing a medical care system and methodologyemploying at least one parameter relating at least to respiration forautomatically providing an output indication relating to at least onemedical condition in accordance with a preferred embodiment of thepresent invention in three different types of care environments.

Turning to FIG. 1A, it is seen that in an out of hospital environment,such as a doctor's office or other ambulatory care facility, variouspatient physiologic activities are sensed and measured, includingrespiratory physiologic activities, preferably via an oral airwayadapter and/or a nasal or nasal/oral cannula 100, such as a Model NasalFilterLine Adult XS 04461, O₂/CO₂ Nasal FilterLine Adult 007141, orSmart CapnoLine Adult (Oral/nasal FilterLine) 007414, commerciallyavailable from Oridion Ltd., of Jerusalem Israel, typically coupled witha capnograph 102, such as a Microcap®, commercially available fromOridion Ltd., of Jerusalem Israel. Other patient physiologic activitiesrelating to cardiac function (e.g. electrocardiogram (ECG)), cerebralperfusion (e.g. CEREBRAL OXIMETRY), oxygenation (e.g. pulse oximetry)and systemic circulation (e.g. . . . blood pressure (NIBP)), may also besensed and measured by suitable instrumentation 104.

The outputs of the capnograph 102 and possibly of additionalinstrumentation 104 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 110, which typicallyanalyzes the respiration parameter output of the capnograph 102, andalso typically has an associated display 112, the display being at leastone of a visual display, such as a computer screen, a virtual display,or a printed form of a display. Optionally further physiologicactivities are outputted from capnograph 102 and instrumentation 104,and provided as outputs via computer 110 and display 112, whichpreferably contain diagnostic statements, which preferably characterizethe type and severity of a medical condition, as well as treatmentrecommendations.

Turning to FIG. 1B, it is seen that in an ambulance environment, variouspatient physiologic activities are sensed and measured, includingrespiratory physiologic activities, preferably via an oral airwayadapter and/or a nasal or nasal/oral cannula 100, such as a such as aNasal FilterLine Adult XS 04461, O₂/CO₂ Nasal FilterLine Adult 007141,or Smart CapnoLine Adult (Oral/nasal FilterLine) 007414, commerciallyavailable from Oridion Ltd., of Jerusalem Israel, typically coupled witha capnograph 113, such as a Microcap®, commercially available fromOridion Ltd., of Jerusalem Israel. Other patient physiologic activitiesrelating to cardiac function (e.g. ECG), cerebral perfusion (e.g.CEREBRAL OXIMETRY), oxygenation (e.g. pulse oximetry) and systemiccirculation (e.g. NIBP), may also be sensed and measured by suitableinstrumentation 114.

The outputs of the capnograph 113 and possibly of additionalinstrumentation 114 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 116, having an associateddisplay 118, which typically analyzes the respiration parameter outputof the capnograph 113 and possibly other parameters and provides anoutput which preferably contains diagnostic statements, which preferablycharacterize the type and severity of a medical condition, as well astreatment recommendations.

Preferably some or all of the outputs of computer 116 are transmitted ina wireless manner by a transmitter 119, such as via radio or a cellulartelephone link, preferably to a dispatch center or patient receivingfacility.

Turning to FIG. 1C, it is seen that in a hospital environment, such asan emergency department, medical ward or intensive care unit (ICU),various patient physiologic activities are sensed and measured,including respiratory physiologic activities, preferably via an oralairway adapter and/or a nasal or nasal/oral cannula 120, such as a NasalFilterLine Adult XS 04461, O₂/CO₂ Nasal FilterLine Adult 007141, orSmart CapnoLine Adult (Oral/nasal FilterLine) 007414, commerciallyavailable from Oridion Ltd., of Jerusalem Israel, typically coupled witha capnograph 122, such as a Microcap®, commercially available fromOridion Ltd., of Jerusalem Israel. Other patient physiologic activitiesrelating to cardiac function (e.g. ECG), cerebral perfusion (e.g.CEREBRAL OXIMETRY), oxygenation (e.g. pulse oximetry) and systemiccirculation (e.g. NIBP), may also be sensed and measured by suitableinstrumentation 124.

The outputs of the capnograph 122 and possibly of additionalinstrumentation 124 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 126 at the patient's bedsideand/or at a central monitoring station, having an associated display128, which typically continuously analyzes the respiration parameteroutput of the capnograph 122 and possibly other parameters and providesan output which preferably contains diagnostic statements, whichpreferably characterize the type and severity of a medical condition, aswell as treatment recommendations.

Reference is now made to FIG. 2, which is a flowchart illustratingoperation of the embodiments of FIGS. 1A-1C.

In a sensing stage, the patient's physiologic activity preferably ismonitored by collecting an expired air sample via cannula 100, andconveying the sample to an analyzer, integrally part of a capnograph,such as capnograph 102 (FIG. 1A), 113 (FIG. 1B), and 122 (FIG. 1C).Simultaneously, some of the patient's other physiological parameters maybe sensed, sampled and monitored employing suitable instrumentation 104(FIG. 1A), 114 (FIG. 1B), and 124 (FIG. 1C). These parameters include,but are not limited to, cardiac activity, ventilation and systemic andcerebral perfusion, and oxygenation parameters.

Data including the parameters monitored and sampled by, for example,instrumentation 104 are relayed to computer 110. The measured patientparameters are analyzed by computer 110 and advisory statements,preferably including at least one of diagnostic statements as to thecharacter and severity of a medical condition and therapeuticrecommendations may be displayed on a display 112, or transmitted to aremote location. Changes in the measured patient parameters are recordedover time by computer 110 and the resulting trends may be displayed ondisplay 112 or transmitted. The trends may also be employed forgenerating trend based advisory statements, preferably including atleast one of diagnostic statements as to the character and severity of amedical condition and therapeutic recommendations.

Typically, the exhaled carbon dioxide of the patient is measuredcontinuously over thirty seconds by capnograph 102. Additionally oralternatively, patient may be measured for shorter or longer durations.The end tidal value of the exhaled carbon dioxide (ETCO₂) profile isdigitized as a waveform and may be stored for analysis in the memory ofsuitably programmed automatic diagnostic and treatment computer 110.Additionally or alternatively, the waveform may be stored and analyzedby other means,

Thereafter, in an analyzing stage, the measured patient parameters, suchas the limits of inspiration and expiration are delineated and/or markedon computer 110. The initial slope in the increase of the exhaled carbondioxide concentration up to 80% of the maximum (henceforth designated as“slope”) and angle of rise up to 80% of the maximum carbon dioxideexhaled are measured.

In a rule application step, the following rules defining the patientstatus preferably are applied by computer 110, for example, to the CO₂profile measured by capnograph 102:

If:

a) the time duration to reach 80% of the maximum CO₂ concentration(designated henceforth as “run” or “CO₂ run”) is greater than 0.3seconds; and,

b) the slope of the increase in concentration of CO₂ is less than 100 mmHg/sec (designated henceforth as “slope” or “CO₂ slope”);

then: an alert signal such as “ALERT: BRONCHOSPASM PRESENT” or “ALERT:ASTHMA PATIENT” is displayed on display 112 associated with computer110.

If the patient is an asthma patient according to the definition of theprevious step, then the patient receives the appropriate treatment.Thereafter, a second set of exhaled carbon dioxide profile measurementsare taken by capnograph 102, and the differences between the initialmeasurements and these second set of measurements are computed bycomputer 110. The following decision rule is preferably applied:

If:

a) the difference in the run is less than 0.1 sec; and

b) the difference in the slope is less than +15 mm Hg/sec;

then,

a message is displayed on display 112 such as “ADMIT PATIENT TOHOSPITAL”. Additionally or alternatively, further tests may be performedfor checking the severity of the patient's condition as are describedhereinbelow.

If the patient is not yet in hospital, as is portrayed in FIGS. 1A and1B, then a typical message is “ADMIT TO HOSPITAL”. Whereas, if thepatient is already in the hospital environment (FIG. 1C), a typicalmessage is “PATIENT REQUIRES URGENT TREATMENT BY PHYSICIAN.”Additionally or alternatively, further tests may be performed forchecking the severity of the patient's condition as are describedhereinbelow.

If the values of the difference in the run and the difference in theslope are beyond those of the decision rule, then another message may bedisplayed such as “PATIENT IMPROVING” on display 112.

Reference is now made to FIG. 3, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology in an on-scene environment for detecting the presence andseverity of bronchospasm, gauging the response to treatment andrecommending disposition of the patient. As seen in FIG. 5, in an onscene environment, such as at a patient's home, after a patient callsEMS after having sensed shortness of breath, various patient physiologicactivities are sensed and measured, including respiratory physiologicactivities, preferably via an oral airway adapter and/or a nasal ornasal/oral cannula 130, such as a Model Nasal FilterLine Adult XS 04461,O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 132, suchas a Microcap®, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 134, a fingersensor 136, a forehead/scalp sensor 138, cannula 130 and a bloodpressure cuff (sphygmomanometer) 140 respectively, may also be sensedand measured by suitable instrumentation 154.

The outputs of the capnograph 132 and preferably of additionalinstrumentation 154 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 144, having an associateddisplay 146, which typically analyzes the respiration parameter outputof the capnograph 132, and preferably other physiologic activities andprovides an output which preferably contains a diagnostic statement,here “ALERT: MODERATE BRONCHOSPASM PRESENT”. The severity of thepatient's condition is defined by measured parameters as describedhereinbelow.

The patient is preferably given breathing treatment, such as a betaagonist nebulizer treatment and following such treatment and/or in thecourse thereof, the physiologic activities of the patient continue to bemonitored. This monitoring is employed by computer 160 to indicate theresponse to the breathing treatment and the current status of thebronchospasm condition. The patient is then transferred to an ambulance.

Reference is now made additionally to FIG. 4, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 3. The patient previously attached to amulti-parameter monitor including a capnograph 132 and suitableinstrumentation 154, by means of cannula 130 and preferably also bymeans of chest electrodes 134, finger sensor 136, forehead sensor 138and blood pressure cuff 140, is monitored continuously for at leastthirty seconds. Neurological status of the patient is acquired by anysuitable technique, including visual and electroencephalograph (EEG)monitoring. Values of CO₂ concentration, ECG, NIBP and the SPO₂ (thepercent saturation of the hemoglobin molecule with oxygen) in units of %saturation (designated as % SAT herein), are continuously monitored, andcarbon dioxide waveforms are preferably digitized as a capnogram 169 andtogether with other waveforms are stored in computer 144.

At least one expired air sample is collected and conveyed for analysisby capnograph 132. The following gold standards of base pulmonaryfunction measures are as follows: FEV1 is defined as the ForcedExpiratory Volume over 1 second, and is a measure of flow. FVC is theForced Vital Capacity and is a measure of volume.

The character ratio is FEV1/FVC. This is the ratio of flow to volume:markedly less than 1 in bronchospasm, and close to a value of 1 inpatients of normal status and those with restrictive disease.

Severity of a pulmonary disease may preferably be defined by FEV1:Reduced flow and/or volume over the first second, as compared to normal.This applies to both obstructive and restrictive disorders.

Forced expiratory volume (FEV) values are preferably determinedemploying, a correlation from at least one capnographic measurement, andare denoted herein as CAP-FEV or CAP-FEV1 (measured over one second).The severity criteria is assessed from the capnogram using a measurethat we refer to as Cap-FEV1, to emphasize it's relation to thegold-standard FEV1 and it's derivation from the Capnogram. The areaunder capnogram 169 is measured over the first second. This, theCAP-FEV1 is computed as (SUM [CO₂] (First second)) or, at 40 Hz devicesampling rate, (SUM (n=0:40) [CO₂]n). The units are “% of expectedvalue”, or “%”. Additionally or alternatively, the CAP-FEV1 may bedetermined by standard spirometry techniques known in the art as isFEV1.

The capnographic analysis preferably includes molecular correlationspectroscopy (MSC), but may also be performed employing infraredanalysis. The outputs of the capnograph 132 and possibly of additionalinstrumentation 154 are preferably supplied to suitably programmedautomatic diagnostic and treatment computer 144, having associateddisplay 146, which typically analyzes the respiration parameter outputof the capnograph 132.

In an analyzing step, computer 144 marks the onset and offset limits ofa capnogram 169, pulse waveforms, and the QRS complex (of the ECG). Theactual parameters measured include, but are not limited to heart rate(HR), BP, the systolic to diastolic ratio (SYS/DIA). SPO₂, AND ETCO₂.The slope of CO₂ (mm Hg/sec), and CO₂ “run”, of the capnogram 132,measured, to 80% of maximum CO₂ concentration, are calculated bycomputer 144.

Following each treatment, computer 144 computes the differences betweenconsecutive measurements of the various patient parameters. Thereafter,in a diagnostic rule application step, the following diagnostic rulesare preferably applied to the measured parameters by computer 144:

1). If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater or equal to than 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 146 shows the message “VITAL SIGNS WITHIN NORMAL        LIMITS.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is more than or equal to 91% SAT but less than 95% SAT;        and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 146.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 (forced expiratory volume in one second) is less        than 50%;    -   b) SPO₂ is less than 92% SAT; and    -   c) ETCO₂ (end tidal value of the exhaled carbon dioxide) is        greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 146.

It should be understood from this example that the severity of the arespiratory disorder, whether restrictive or obstructive, may bedetermined by CAP-FEV1 measurements. The use of the capnographicmeasurements for diagnosis of whether the respiratory disorder isrestrictive or obstructive is described in FIG. 30 hereinbelow.Similarly, the ratio CAP-FEV1/FVC (forced vital capacity) may be appliedto diagnose whether the patient is suffering from a restrictive orobstructive breathing disorder as is described hereinabove.

Reference is now made to FIG. 5, which is also a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology in an on-scene environment for detecting the presence andseverity of bronchospasm, gauging the response to treatment andrecommending disposition of the patient. As seen in FIG. 5 and similarlyto that described hereinabove with reference to FIG. 3, in an on sceneenvironment, such as at a patient's home, after a patient calls EMSafter having sensed shortness of breath, various patient physiologicactivities are sensed and measured, including respiratory physiologicactivities, preferably via an oral airway adapter and/or a nasal ornasal/oral cannula 150, such as a Model Nasal FilterLine Adult XS 04461,O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 152, suchas a Microcap®, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 154, a fingersensor 156, a forehead/scalp sensor 158 and a blood pressure cuff 160respectively, and may also be sensed and measured by suitableinstrumentation 154.

The outputs of the capnograph 152 and preferably of additionalinstrumentation 154 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 160, having an associateddisplay 162, which typically analyzes the respiration parameter outputof the capnograph 152 and preferably other physiologic activities andprovides an output which preferably contains a diagnostic statement,here “ALERT: SEVERE BRONCHOSPASM PRESENT”.

The patient is given breathing treatment, such as a beta agonistnebulizer treatment and following such treatment and/or in the coursethereof, the physiologic activities of the patient continue to bemonitored. This monitoring is employed by computer 160 to indicate theresponse to the breathing treatment and the current status of thebronchospasm condition. In the scenario of FIG. 3, the patient fails torespond sufficiently to the breathing treatment and this is indicated bya status statement, here “POOR RESPONSE TO TREATMENT, CONDITIONCRITICAL”. A treatment recommendation may also be provided, such as“CONSIDER INTUBATION”.

Intubation is performed and correct intubation tube placement isconfirmed by continuing monitoring of the physiologic activities of thepatient. A status statement, here: “ADEQUATE CO₂ WAVEFORM—TUBE INTRACHEA” and a treatment recommendation, here “SECURE TUBE” appear.

The patient is then transferred to an ambulance. While the physiologicactivities of the patient continue to be monitored and serve to confirmcontinued proper placement of the intubation tube in the trachea. Astatus statement, here “TUBE IN TRACHEA” appears. Typically, theposition of the tube is continuously monitored by computer 160, and astatus statement “MONITORING TUBE POSITION” appears on display 162.

Reference is now made additionally to FIGS. 6A and 6B, which illustratethe operation of the system and methodology of the system of the presentinvention in the context of FIG. 5. In a monitoring step, the patient,attached to a multi-parameter monitor including a capnograph 152 andinstrumentation 154, by means of cannula 150 and preferably also bymeans of chest electrodes 164, finger sensor 166, forehead/scalp sensor158 and blood pressure cuff 168, is monitored. Neurological status ofthe patient is acquired by any suitable technique.

At least one expired air sample is collected and conveyed to capnograph152. Further measurements of ECG and blood pressure are monitored bystandard techniques, employing chest electrodes 164 and blood pressurecuff 168 respectively. The actual parameters measured include, but arenot limited to heart rate, blood pressure ETCO₂ and SPO₂ (SYS/DIA).SPO₂, NIBP, and cerebral oximetry values, and these parameters aremeasured and/or determined continuously by techniques as detailedhereinabove. These parameter values are typically digitized as waveformsand are further stored for analysis by computer 160.

In an analyzing step, the onset and offset limits of capnograph 152,pulse waveforms, and the QRS complex (ECG) measured by additionalinstrumentation 154, are delineated and marked by computer 160. Thelimits of the capnogram, the pulse waveform and QRS onset and offset aredetermined and recorded in computer 160. The slope of the capnogram (mmHg/sec), and the run and thereof is measured to 80% of maximum CO₂concentration are calculated by computer 160.

Thereafter, in a diagnostic rule application step, the followingdiagnostic rules are applied to the measured parameters by computer 160:

1. if:

-   -   a) the blood pressure values are within the normal range;    -   b) respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   computer 160 displays a message “NO BRONCHOSPASM PRESENT” on        display 162.

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is more than or equal to 91% SAT, but less than 95% SAT;        and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   computer 160 provides the message “MODERATE BRONCHOSPASM        PRESENT” on display 162.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is more than or equal to 90% SAT, but is less than 91%        SAT; and    -   c) ETCO₂ is greater than 45 mm Hg, but less than or equal to 60        mm Hg;

then,

-   -   computer 160 provides a message “SEVERE BRONCHOSPASM PRESENT” on        display 162.

4. If the parameters measured are still yet further removed from theacceptable range, such as if:

-   -   a) SPO₂ is less than 90% SAT;    -   b) the respiratory rate is less than 8 per minute;    -   c) ETCO₂ is greater than 60 mm Hg; and    -   d) the neurological parameters are poor;

then,

-   -   computer 160 issues a message on display 162 stating        “RESPIRATORY FAILURE; CONDITION CRITICAL; CONSIDER INTUBATION”.

Subsequently, in an intubation stage, a standard intubation procedure isfollowed, as is described hereinabove in FIG. 5. Thereafter, anoperator, typically a physician or paramedic, confirms that theintubation monitoring mode has been activated, and the patient ismonitored for a successful outcome of the intubation. Thereafter,computer 160 displays a message stating “MONITORING FOR INTUBATION” ondisplay 162.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 152.

The following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15;

then,

-   -   a display is provided by computer 160 stating “GOOD WAVEFORM,        TUBE IN TRACHEA, CONFIRM AND SECURE TUBE” on display 162.

Thereafter, the ETCO₂ value is measured again by capnograph 152, andrecorded by computer 160. The following monitoring rules are preferablyapplied.

1). If

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a message is displayed by computer 160 on display 162 stating        “MONITORING TUBE IN POSITION: NO DISLODGEMENT.”

2) Whereas, if:

-   -   a) the ETCO₂ value is less than or equal to 15 mm Hg; or    -   b) there is a loss in the tracking of the waveform by capnograph        152;

then,

-   -   a message is displayed by computer 160 stating “ALERT: CHECK FOR        TUBE DISLODGEMENT” on display 162.

Reference is now made FIG. 7, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology in an ambulance environment for detecting the presence andseverity of bronchospasm, gauging the response to treatment andrecommending disposition of spontaneously breathing patients. As seen inFIG. 7, in an ambulance environment, various patient physiologicactivities are sensed and measured, including respiratory physiologicactivities, preferably via an oral airway adapter and/or a nasal ornasal/oral cannula 170, such as a Model Nasal FilterLine Adult XS 04461,O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 172, suchas a Microcap®, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 174, a fingersensor 176, a forehead/scalp sensor 178 and a blood pressure cuff 180respectively, may be received and analyzed by additional instrumentation182.

The outputs of the capnograph 172 and possibly of additionalinstrumentation 182 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 184, having an associateddisplay 186, which typically analyzes the respiration parameter outputof the capnograph 172 and possibly other parameters and provides anoutput which preferably contains a diagnostic statement, here “ALERT:MODERATE BRONCHOSPASM PRESENT”. A breathing treatment is administeredafter which a diagnostic statement which indicates the patient statusand the severity of the respiratory condition is preferably presented,here “GOOD RESPONSE TO TREATMENT, CONDITION IMPROVING”. Additionalbreathing treatment is typically administered after which a diagnosticstatement which indicates the current patient status and the severity ofthe respiratory condition is preferably presented, here “NO BRONCHOSPASMPRESENT, CONDITION STABLE”.

Preferably, response to treatment statements as well as dispositionrecommendations may be appended to patient status statements, here“RAPID RESPONSE TO TREATMENT, CONDITION REMAINS STABLE, DISCHARGE TOHOME LIKELY”.

Preferably some or all of the outputs of computer 184 are transmitted ina wireless manner by a transmitter 188, such as via radio or a cellulartelephone link, preferably to a dispatch center or patient receivingfacility.

Reference is now made additionally to FIGS. 8A and 8B, which illustratethe operation of the system and methodology of the system of the presentinvention in the context of FIG. 7. In a monitoring step, the patient inan ambulance environment, attached to a multi-parameter monitorincluding capnograph 172, by means of cannula 170 and preferably also bymeans of chest electrodes 174, finger sensor 176, scalp/forehead sensor178 and blood pressure cuff 178, is monitored continuously. Neurologicalstatus of the patient is acquired by any suitable technique. Values ofthe CO₂ concentration monitored by capnograph 172, and ECG, NIBP,cerebral oximetry and SPO₂ values, monitored by additionalinstrumentation 182 are supplied to computer 184, and are typicallymeasured continuously over a period of 30 seconds, by techniques asdetailed hereinabove. The parameter data may be digitized as waveformsand are further stored for analysis by computer 184. Thereafter, thelimits of the capnogram, the pulse waveform and QRS onset and offset aredetermined by computer 184. The heart rate, blood pressure ETCO₂ andSPO₂ values are measured. The initial slope of the capnogram and therun, monitored by capnograph 172, are calculated by computer 184.Additionally, neurological findings, monitored by means of an EEG areinputted to computer 184.

In an analyzing step, the onset and offset limits of the capnogram,pulse waveforms, and the QRS complex (ECG) are marked by computer 184.

Following each treatment, the differences between consecutivemeasurements of the various patient parameters are evaluated by computer184. After each treatment, in a diagnostic rule application step, thefollowing diagnostic rules are preferably applied to the measuredparameters by computer 184:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 162 shows the message “NO BRONCHOSPASM PRESENT”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is more than or equal to 91% SAT less than 95% SAT; and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 186.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 92% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 186.

The findings of the last stage are stored by computer 184 and/ortransmitted to a dispatch/receiving center, typically located at ahospital or medical center [ref. no]. A connection is established withthe dispatch/receiving, center [ref. no], and the data is forwardedthereto. A medical supervisor typically watches display of the receiveddata, and consequentially transmits the recommended treatment and/ortransport recommendations back to the ambulance.

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 184. Thereafter; the followingmonitoring rules are preferably applied to the measured parameters bycomputer 184.

1) If:

-   -   a) the difference in the run values is greater than +0.1 sec;        and    -   b) the difference in the slope is more negative than −15 mm        Hg/sec;

then,

-   -   computer 184 displays on display 186 “BRONCHOSPASM WORSENING”.

2) If:

-   -   a) the difference in the run values is more negative than −0.1        sec; and    -   b) the difference in the slope is more than +15 mm Hg/sec;

then,

-   -   computer 184 displays on display 186 “BRONCHOSPASM IMPROVING”.

3) If:

-   -   a) the difference in the slope is more than or equal to −15 mm        Hg/sec and less in than or equal to +15 mm Hg/sec;

then,

-   -   computer 184 displays on display 186 “UNCHANGED”.

The change in patient's vital functional activities, including SPO₂ andETCO₂, over the time interval are calculated by computer 184.

4) If:

-   -   a) the decrease in SPO₂ is more than −5% SAT; or    -   b) the increase in the ETCO₂ is more than +5 mm Hg;

then,

-   -   computer 184 displays on display 186 “VITAL SIGNS        DETERIORATING.”

5) If:

-   -   a) the increase in SPO₂ is greater than +5% SAT; or    -   b) the decrease in the ETCO₂ is less than −5 mm Hg;

then,

-   -   computer 184 displays on display 186 “VITAL SIGNS IMPROVING”.

6) If:

-   -   a) the change in SPO₂ is greater than or equal to −5% SAT, but        less than or equal to +5%; or    -   b) the change in the ETCO₂ is more than or equal to −5 mm Hg, or        less than or equal to +5 mm Hg;

then.

-   -   computer 184 displays on display 186 “VITAL SIGNS UNCHANGED.”

Computer 184 preferably combines the results of these monitoring rulesto display an integrated display 186 such as “BRONCHOSPASM WORSENING;VITAL SIGNS UNCHANGED.”

Thereafter, in a transmission stage, the connection with the receivingcenter is maintained. The receiving center periodically receives updatesof the patient's condition, who is in the ambulance en route to thehospital, in order to prepare in the most fitting and efficient transferof the patient upon arrival to the hospital.

Following the transmission stage, the following exit rules arepreferably applied to the measured parameters by computer 184:

1) If:

a) the blood pressure values are within normal limits;

b) the respiratory rate is within normal limits;

c) the value of the CO₂ run is less than 0.3 seconds; and

d) the CO₂ slope is greater than 100 mm Hg/sec;

then,

Computer 184 preferably displays on display 186 “NO BRONCHOSPASMPRESENT”.

If the patient's record complies with this exit rule, then a copy of thepatient's record is handed off from computer 184 to the receivingcenter, for example, in the form of a chart. Typically, the receivingcenter stores this chart, so that it may be used as a baseline forcontinued monitoring of the patient.

Reference is now made to FIG. 9, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology in an ambulance environment for detecting the presence andseverity of bronchospasm, gauging the response to treatment andrecommending disposition of mechanically ventilated patients. As seen inFIG. 9 and similarly to that described hereinabove with reference toFIG. 5, in an ambulance environment various patient physiologicactivities are sensed and measured, including respiratory physiologicactivities, preferably via an oral airway adapter and/or a nasal ornasal/oral cannula 200, such as a Model Nasal FilterLine Adult XS 04461,O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 202, suchas a Microcap®, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 204, a fingersensor 206, a forehead/scalp sensor 208 and a blood pressure cuff 209respectively, may also be sensed and measured by suitableinstrumentation 210. Other patient physiologic activities relating tocardiac function (e.g. ECG), cerebral perfusion (e.g. CEREBRALOXIMETRY), oxygenation (e.g. pulse oximetry) and systemic circulation(e.g. NIBP), may also be sensed and measured by suitable instrumentation212

The outputs of the capnograph 202 and preferably of additionalinstrumentation 212 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 214 having an associateddisplay 216, which typically analyzes the respiration parameter outputof the capnograph 202 and preferably other physiologic activities andprovides an output which preferably contains a diagnostic statement,here “ALERT: SEVERE BRONCHOSPASM PRESENT”.

The patient is given breathing treatment, such as a beta agonistnebulizer treatment and following such treatment and/or in the coursethereof, the physiologic activities of the patient continue to bemonitored. This monitoring is employed by computer 214 to indicate theresponse to the breathing treatment and the current status of thepatient condition. In the scenario of FIG. 9, the patient fails torespond sufficiently to the breathing treatment and this is indicated bya status change statement, here “POOR RESPONSE TO TREATMENT, CONDITIONWORSENING”. A treatment recommendation may also be provided, such as“CONSIDER INTUBATION”.

Intubation is performed and correct initial tube placement is confirmedfollowed by continuous monitoring of the physiologic activities of thepatient, which indicate current tube position. Where intubation issuccessful, a status statement, here: “ADEQUATE CO2 WAVEFORM—TUBE INTRACHEA” and a treatment recommendation, here “SECURE TUBE” appear.Where intubation is not successful, a status statement, here: “NO CO2WAVEFORM—TUBE IN ESOPHAGUS” and a treatment recommendation, here“REINTUBATE” appear.

Following successful intubation, continuous monitoring may provide astatus statement such as “ADEQUATE CO2 WAVEFORM-TUBE IN TRACHEA—NODISLOGEMENT” may appear. If tube dislodgment occurs at any timefollowing intubation, a status statement appears, here “CO2 WAVEFORMABSENT” preferably accompanied by a treatment recommendation, here“CHECK FOR TUBE DISLOGEMENT”.

Preferably some or all of the outputs of computer 214 are transmitted ina wireless manner by a transmitter 218, such as via radio or a cellulartelephone link, preferably to a dispatch center or patient receivingfacility.

Reference is now made additionally to FIGS. 10A-10C, which illustratethe operation of the system and methodology of the system of the presentinvention in the context of FIG. 9.

In a monitoring step, the patient in an ambulance environment, attachedto a multi-parameter monitor including capnograph 202 andinstrumentation 212, by means of cannula 200 and preferably also bymeans of chest electrodes 204, finger sensor 206, scalp/forehead sensor208 and blood pressure cuff 209, is monitored continuously, Neurologicalstatus of the patient is acquired by any suitable technique. Values ofthe CO₂ concentration monitored by capnograph 202, and ECG, NIBP,cerebral oximetry and SPO₂ values, monitored by additionalinstrumentation 212 are supplied to computer 214, and are typicallymeasured continuously over a period of 30 seconds, by techniques asdetailed hereinabove. The parameter data may be digitized as waveformsand are further stored for analysis by computer 214. Thereafter, theonset and offset limits of the capnogram, the pulse waveform and QRSonset and offset are determined by computer 214. The heart rate, bloodpressure ETCO₂ and SPO₂ values are measured. The initial slope of thecapnogram and the run, monitored by capnograph 202, are calculated bycomputer 214. Additionally, neurological findings, monitored by means ofan EEG are inputted to computer 214.

Following each treatment, the differences between consecutivemeasurements of the various patient parameters are evaluated by computer214. After each treatment, in a diagnostic rule application step, thefollowing diagnostic rules are preferably applied to the measuredparameters by computer 214:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 216 shows the message “NO BRONCHOSPASM PRESENT.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is more than or equal to 91% SAT but less than 95% SAT;        and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 216.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 91% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is preferably        displayed on display 216.

The findings of the last stage are stored by computer 214 and/ortransmitted to a dispatch/receiving center, typically located at ahospital or medical center]. A connection is established with thedispatch/receiving center, and the data is forwarded thereto. A medicalsupervisor typically watches display of the received data, andconsequentially transmits the recommended treatment and/or transportrecommendations back to the ambulance.

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 214: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 214.

1) If:

-   -   a) the difference in the run values is greater than 0.1 sec; and    -   b) the difference in the slope is more negative than −15 mm        Hg/sec;

then,

-   -   computer 214 displays on display 216 “BRONCHOSPASM WORSENING”.

2) If:

-   -   a) the difference in the run values is more negative than −0.1        sec; and    -   b) the difference in the slope is more positive than +15 mm        Hg/sec;

then,

-   -   computer 214 displays on display 216 “BRONCHOSPASM IMPROVING”.

3) If:

-   -   a) the difference in the slope is more than or equal to −15 mm        Hg/sec and less than or equal to +15 mm Hg/sec;

then,

-   -   computer 214 displays on display 216 “BRONCHOSPASM UNCHANGED”.

The change in patient's vital functional activities, including SPO₂ andETCO₂, over the time interval are calculated by computer 214.

4) If:

-   -   a) the decrease in SPO₂ is more negative than −5% SAT; or    -   b) the increase in the ETCO₂ is more positive than +5 mm Hg;

then,

-   -   computer 214 displays on display 216 “VITAL SIGNS        DETERIORATING.”

5) If:

-   -   a) the change in SPO₂ is greater than +5% SAT; or    -   b) the change in the ETCO₂ is more negative than −5 mm Hg;

then,

-   -   computer 214 displays on display 216 “VITAL SIGNS IMPROVING”.

6) If:

-   -   a) the change in SPO₂ is greater than or equal to −5% SAT, but        less than or equal to +5% SAT; or    -   b) the change in the ETCO₂ is more than or equal to −5 mm Hg,        but less than or equal to +5 mm Hg;

then,

-   -   computer 214 displays on display 216 “VITAL SIGNS UNCHANGED.”

Computer 214 preferably combines the results of these monitoring rulesto display an integrated display such as “BRONCHOSPASM WORSENING; VITALSIGNS UNCHANGED.”

In a checking rule step, the following rule is preferably applied:

1) A patient appears to be entering respiratory failure phase if:

-   -   a) the SPO₂ is less than 90% SAT;    -   b) the respiratory rate is less than 8/min;    -   c) ETCO₂ is greater than 60 mm Hg; and    -   d) the patient's neurological symptoms are qualified as being        “bad”;

then,

-   -   computer 214 displays “RESPIRATORY FAILURE; CONDITION CRITICAL;        CONSIDER INTUBATION.” on display 216.

Following this, in an alert data transmission stage, a high priorityupdate is transmitted via transmitter 218 from computer 214 to notifythe dispatch/receiving centers of the significant deterioration andchange in the patient's condition.

Once these changes in the patient's condition have been confirmed by anoperator, the patient is consequentially intubated according to standardtechniques and capnograph 202 is activated in intubation monitoring modeby computer 214. Once the successful intubation of the patient isverified by data comparison of the patient's capnogram and standardizedcapnograms for intubation in computer 214, the computer displays“MONITORING FOR INTUBATION”.

Thereafter, the following check rule is preferably applied to thepatient's capnogram:

1. If:

-   -   a) ETCO₂ is greater than 15 mm Hg;

then,

-   -   computer 214 displays “GOOD WAVEFORM, TUBE IN TRACHEA. CONFIRM        AND SECURE TUBE.”

In the next step, the following monitoring rules are preferably appliedto the patient's capnogram:

1) If:

-   -   a) the value of ETCO₂ is greater than 15 mm Hg;

then,

-   -   computer 214 displays “MONITORING TUBE POSITION: NO        DISLODGEMENT” on display 216.

2) If:

-   -   a) the value of ETCO₂ is less than or equal to 15 mm Hg; or    -   b) there is a loss of the waveform;

then,

-   -   computer 214 displays “ALERT: CHECK FOR TUBE DISLODGEMENT” on        display 216.

Computer 214 transmits the data monitored via transmitter 218 to thereceiving center. The receiving center periodically receives updates ofthe patient's condition, who is in the ambulance en route to thehospital, in order to prepare in the most fitting and efficient transferof the patient upon arrival to the hospital.

A copy of the patient's record is handed off from computer 184 viatransmitter 218 to the receiving center, for example, in the form of achart. Typically, the receiving center stores this chart, so that it maybe used as a baseline for continued monitoring of the patient.

Reference is now made to FIG. 11, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology in a hospital environment, such as a medical ward, emergencydepartment or ICU, for detecting the presence and indicating theseverity of bronchospasm, gauging the response to treatment andrecommending treatment and disposition of spontaneously breathingpatients. As seen in FIG. 11, in a hospital environment, various patientphysiologic activities are sensed and measured, including respiratoryphysiologic activities, preferably via an oral airway adapter and/or anasal or nasal/oral cannula 220, such as a Model Nasal FilterLine AdultXS 04461, O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 222, suchas a Microcap®, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 224, a fingersensor 226, a forehead/scalp sensor 228 and a blood pressure cuff 230respectively.

The outputs of the capnograph 222 and possibly of additionalinstrumentation 230 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 232, having an associateddisplay 234 which typically analyzes the respiration parameter output ofthe capnograph 222 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement, here “ALERT: MODERATEBRONCHOSPASM PRESENT”. A breathing treatment is administered after whicha diagnostic statement which indicates the patient status and theseverity of the respiratory condition is preferably presented, here“GOOD RESPONSE TO TREATMENT, CONDITION IMPROVING”. Additional breathingtreatment is typically administered after which a diagnostic statementwhich indicates the current patient status and the severity of therespiratory condition is preferably presented, here “NO BRONCHOSPASMPRESENT, CONDITION STABLE”.

Preferably, response to treatment statements as well as dispositionrecommendations may be appended to patient status statements, here“RAPID RESPONSE TO TREATMENT, CONDITION REMAINS STABLE, DISCHARGE TOHOME LIKELY”.

Reference is now made additionally to FIG. 12, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 11. The patient in the hospitalenvironment, preferably attached to a multi-parameter monitor includingcapnograph 222 and instrumentation 230, by means of cannula 220 andpreferably also by means of chest electrodes 230, finger sensor 226,scalp/forehead sensor 228 and blood pressure cuff 236, is monitoredcontinuously. The neurological status of the patient is acquired by anysuitable technique. Values of CO₂ concentration, ECG, NIBP and SPO₂ arecontinuously measured, typically over a period of 30 seconds, and carbondioxide waveforms are preferably digitized as a capnogram and otherwaveforms and stored.

The parameter data may be digitized as waveforms and are further storedfor analysis by computer 232. Thereafter, the onset and offset limits ofthe capnogram, the pulse waveform and QRS onset and offset aredetermined by computer 232. The heart rate, blood pressure ETCO₂ andSPO₂ values are measured. The initial slope of the capnogram and therun, monitored by capnograph 222, are calculated by computer 232.Additionally, neurological findings, monitored by means of an EEG areinputted to computer 232.

Following each treatment, the differences between consecutivemeasurements of the various patient parameters are evaluated by computer232. After each treatment, in a diagnostic rule application step, thefollowing diagnostic rules are preferably applied to the measuredparameters by computer 234:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 234 shows the message “VITAL SIGNS WITHIN NORMAL        LIMITS.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is more than or equal to 91% SAT, but less than 95% SAT;        and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 234.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 92% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 234.

The findings of the last stage are stored by computer 232 and/ortransmitted to a dispatch/receiving center, typically located at ahospital or medical center. A connection is established with thedispatch/receiving center, and the data is forwarded thereto. A medicalsupervisor typically watches display of the received data, andconsequentially transmits the recommended treatment and/or transportrecommendations back to the hospital.

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 232: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 232.

1) If:

-   -   a) the difference in the run values is greater than 0.1 sec; and    -   b) the difference in the slope is less than −15 mm Hg/sec;

then,

-   -   computer 232 displays on display 234 “BRONCHOSPASM WORSENING”.

2) If:

-   -   a) the difference in the run values is more negative than −0.1        sec; and    -   b) the difference in the slope is more than +15 mm Hg/sec;

then,

-   -   computer 232 displays on display 234 “BRONCHOSPASM IMPROVING”.

3) If:

-   -   a) the difference in the slope is greater than or equal to −15        mm Hg/sec, but less than or equal to +15 mm Hg/sec; and    -   a) the difference in the run values is greater or equal to −0.1        sec; but less than or equal to +0.1 sec;

then,

-   -   computer 232 displays on display 234 “BRONCHOSPASM UNCHANGED”.

The change in patient's vital functional activities, including SPO₂ andETCO₂, over the time interval are calculated by computer 232.

4) If:

-   -   a) the change in SPO₂ is greater than −5% SAT; or    -   b) the change in the ETCO₂ is more than +5 mm Hg;

then,

-   -   computer 232 displays on display 234 “VITAL SIGNS        DETERIORATING.”

5) If:

-   -   a) the change in SPO₂ is greater than +5% SAT; or    -   b) the change in the ETCO₂ is less than −5 mm Hg;

then,

-   -   computer 232 displays on display 234 “VITAL SIGNS IMPROVING”.

6) If:

-   -   a) the change in SPO₂ is greater than or equal to −5% SAT, and        less than or equal to +5% SAT; or    -   b) the change in the ETCO₂ is more than or equal to −5 mm Hg,        but less than or equal to +5 mm Hg;

then,

-   -   computer 232 displays on display 234 “VITAL SIGNS UNCHANGED.”

Computer 232 preferably combines the results of these monitoring rulesto display an integrated display 234 such as “BRONCHOSPASM WORSENING;VITAL SIGNS UNCHANGED.”

Following the monitoring stage, the following exit rules are preferablyapplied to the measured parameters of the patient by computer 232:

1) If:

-   -   a) the blood pressure values are within normal limits;    -   b) the respiratory rate is within normal limits;    -   c) the value of the CO₂ run is less than 0.3 seconds;    -   d) the CO₂ slope is greater than 100 mm Hg/sec; and    -   e) ETCO₂ is less than 45 mm Hg;

then,

Computer 232 preferably displays on display 234 “NO BRONCHOSPASMPRESENT”

(If the patient's record complies with this exit rule, then a copy ofthe patient's record is handed off from computer 232 to the receivingcenter, for example, in the form of a chart. Typically, the receivingcenter stores this chart, so that it may be used as a baseline forcontinued monitoring of the patient).

Reference is now made to FIG. 13, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology in an ambulance environment for detecting the presence andseverity of bronchospasm, gauging the response to treatment andrecommending disposition of mechanically ventilated patients. As seen inFIG. 13 and similarly to that described hereinabove with reference toFIGS. 5 and 9, in a hospital environment, such as a medical ward,emergency department or ICU, various patient physiologic activities aresensed and measured, including respiratory physiologic activities,preferably via an oral airway adapter and/or a nasal or nasal/oralcannula 250, such as a Model Nasal FilterLine Adult XS 04461,O₂/CO₂Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 252, suchas a Microcap®, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 254, a fingersensor 256, a forehead/scalp sensor 258 and a blood pressure cuff 260respectively, may also be sensed and measured by suitableinstrumentation 262.

The outputs of the capnograph 252 and preferably of additionalinstrumentation 262 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 264 having an associateddisplay 266, which typically analyzes the respiration parameter outputof the capnograph 252 and preferably other physiologic activities andprovides an output which preferably contains a diagnostic statement,here “ALERT: SEVERE BRONCHOSPASM PRESENT”.

The patient is given breathing treatment, such as a beta agonistnebulizer treatment and following such treatment and/or in the coursethereof, the physiologic activities of the patient continue to bemonitored. This monitoring is employed by computer 264 to indicate theresponse to the breathing treatment and the current status of thepatient condition. In the scenario of FIG. 13, the patient fails torespond sufficiently to the breathing treatment and this is indicated bya status change statement, here “POOR RESPONSE TO TREATMENT, CONDITIONWORSENING”. A treatment recommendation may also be provided, such as“CONSIDER INTUBATION”.

Intubation is performed and correct initial tube placement is confirmedfollowed by continuous monitoring of the physiologic activities of thepatient, which indicate current tube position. Where intubation issuccessful, a status statement, here: “ADEQUATE CO2 WAVEFORM—TUBE INTRACHEA” and a treatment recommendation, here “SECURE TUBE” appear.Where intubation is not successful, a status statement, here: “NO CO2WAVEFORM TUBE IN ESOPHAGUS” and a treatment recommendation, here“REINTUBATE” appear.

Following successful intubation, continuous monitoring may provide astatus statement such as “ADEQUATE CO2 WAVEFORM—TUBE IN TRACHEA—NODISLOGEMENT” may appear. If tube dislodgment occurs at any timefollowing intubation, a status statement appears, here “CO2 WAVEFORMABSENT” preferably accompanied by a treatment recommendation, here“CHECK FOR TUBE DISLOGEMENT”.

Preferably some or all of the outputs of computer 262 are transmitted ina wireless manner by a transmitter 268, such as via radio or a cellulartelephone link, preferably to a dispatch center or patient receivingfacility.

Reference is now made additionally to FIGS. 14A and 14B, whichillustrate the operation of the system and methodology of the system ofthe present invention in the context of FIG. 13.

The patient in the hospital environment, preferably attached to amulti-parameter monitor including capnograph 252 and instrumentation262, by means of cannula 250 and preferably also by means of chestelectrodes 254, finger sensor 256, scalp/forehead sensor 258 and bloodpressure cuff 260, is monitored continuously. The neurological status ofthe patient is acquired by any suitable technique. Values of CO₂concentration, ECG, NIBP and SPO₂ are continuously measured, typicallyover a period of 30 seconds, and carbon dioxide waveforms are preferablydigitized as a capnogram and other waveforms and stored by computer 264.

Thereafter, the onset and offset limits of the capnogram, the pulsewaveform and QRS onset and offset are determined by computer 264. Theheart rate, blood pressure ETCO₂ and SPO₂ values are measured. Theinitial slope of the capnogram and the run, monitored by capnograph 252,are calculated by computer 264. Additionally, neurological findings,monitored by means of an EEG are inputted to computer 264. Followingeach treatment, the differences between consecutive measurements of thevarious patient parameters are evaluated by computer 264. After eachtreatment, in a diagnostic rule application step, the followingdiagnostic rules are preferably applied to the measured parameters bycomputer 264:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm. Hg;

then,

-   -   display 266 shows the message “VITAL SIGNS WITHIN NORMAL        LIMITS.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is greater than or equal to 91% SAT, but less than 95%        SAT; and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 266.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 91% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 266.

The findings of the last stage are stored by computer 264 and/ortransmitted by transmitter 268 to a dispatch/receiving center, typicallylocated at a hospital or medical center. A connection is establishedwith the dispatch/receiving center [ref. no], and the data is forwardedthereto. A medical supervisor typically watches display of the receiveddata, and consequentially transmits the recommended treatment and/ortransport recommendations back to the hospital.

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 264: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 264.

1) If:

-   -   a) the difference in the run values is greater than +0.1 sec;        and    -   b) the difference in the slope is more negative than −15 mm        Hg/sec;

then,

-   -   computer 264 displays on display 266 “BRONCHOSPASM WORSENING”.

2) If:

-   -   a) the difference in the run values is more negative than −0.1        sec; and    -   b) the difference in the slope is more positive than +15 mm        Hg/sec;

then,

-   -   computer 264 displays on display 266 “BRONCHOSPASM IMPROVING”.

3) If:

-   -   a) the difference in the run values is greater or equal to −0.1        sec but less than or equal to +0.1 sec; or    -   b) the difference in the slope is more than or equal to −15 mm        Hg/sec but less than or equal to +15 mm Hg/sec;

then,

-   -   computer 264 displays on display 266 “BRONCHOSPASM UNCHANGED”.

The change in patient's vital functional activities, including SPO₂ andETCO₂, over the time interval are calculated by computer 264.

4) If:

-   -   a) the change in SPO₂ is greater than −5% SAT; or    -   b) the change in the ETCO₂ is more than +5 mm Hg;

then,

-   -   computer 264 displays on display 266 “VITAL SIGNS        DETERIORATING.”

5) If:

-   -   a) the change in SPO₂ is greater than +5% SAT; or    -   b) the change in the ETCO₂ is less than −5 mm Hg;

then,

-   -   computer 264 displays on display 266 “VITAL SIGNS IMPROVING”.

6) If:

-   -   a) the change in SPO₂ is greater than or equal to −5% SAT, but        less than or equal to +5% SAT; or    -   b) the change in the ETCO₂ is more than or equal to −5 mm Hg,        but less than or equal to +5 mm Hg;

then,

-   -   computer 264 displays on display 266 “VITAL SIGNS UNCHANGED.”

Computer 264 preferably combines the results of these monitoring rulesto display an integrated display 266 such as “BRONCHOSPASM WORSENING;VITAL SIGNS UNCHANGED.”

In a checking rule step, the following rule is preferably applied:

1) A patient appears to be entering respiratory failure phase if:

-   -   a) the SPO₂ is less than 90% SAT;    -   b) the respiratory rate is less than 8/min;    -   c) ETCO₂ is greater than 60 mm Hg; and    -   d) the patient's neurological symptoms are qualified as being        “bad”;

then,

-   -   computer 264 displays “RESPIRATORY FAILURE; CONDITION CRITICAL;        CONSIDER INTUBATION.” on display 266.

Once these changes in the patient's condition have been confirmed by anoperator, the patient is consequentially intubated according to standardtechniques and capnograph 252 is activated in intubation monitoring modeby computer 264. Once the successful intubation of the patient isverified by data comparison of the patient's capnogram and standardizedcapnograms for intubation in computer 264, the computer displays“MONITORING FOR INTUBATION”.

Thereafter, the following check rule is preferably applied to thepatient's capnogram:

1. If:

-   -   a) ETCO₂ is greater than 15 mm Hg;

then,

-   -   computer 264 displays “GOOD WAVEFORM, TUBE IN TRACHEA. CONFIRM        AND SECURE TUBE.”

In the next step, the following monitoring rules are preferably appliedto the patient's capnogram:

1) If:

-   -   a) the value of ETCO₂ is greater than 15 mm Hg;

then,

-   -   computer 266 displays “MONITORING TUBE POSITION: NO        DISLODGEMENT” on display 268.

2) If:

-   -   a) the value of ETCO₂ is less than or equal to 15 mm Hg; or    -   b) there is a loss of the waveform;

then,

-   -   computer 264 displays “ALERT: CHECK FOR TUBE DISLODGEMENT” on        display 266.

Reference is now made to FIG. 15, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology in a hospital environment operative for distinguishingbetween heart failure and emphysema in a situation where a hospitalpatient becomes short of breath. As seen in FIG. 15, in a hospitalenvironment, various patient physiologic activities are sensed andmeasured, including respiratory physiologic activities, preferably viaan oral airway adapter and/or a nasal or nasal/oral cannula 270, such asa Model Nasal FilterLine Adult XS 04461, O₂/CO₂ Nasal FilterLine Adult007141, or Smart CapnoLine Adult (Oral/nasal FilterLine) 007414,commercially available from Oridion Ltd., of Jerusalem Israel, typicallycoupled with a capnograph 272, such as a Microcap, commerciallyavailable from Oridion Ltd., of Jerusalem Israel. Other patientphysiologic activities relating to cardiac function (e.g. ECG), systemicoxygenation (e.g. pulse oximetry), cerebral oxygenation (e.g. cerebraloximetry) and systemic circulation (e.g. NIBP), typically sensed bymeans of chest electrodes 274, a finger sensor 276, a forehead/scalpsensor 278 and a blood pressure cuff 280 respectively, may also besensed and measured by suitable instrumentation 282.

The outputs of the capnograph 272 and possibly of additionalinstrumentation 282 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 284, having an associateddisplay 286 which typically analyzes the respiration parameter output ofthe capnograph 272 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement, here “SEVEREBRONCHOSPASM PRESENT”. This diagnostic statement would suggest treatmentfor emphysema rather than for heart failure. Breathing treatment isadministered after which a diagnostic statement which indicates thepatient status and the severity of the respiratory condition ispreferably presented, here “MODERATE BRONCHOSPASM, CONDITION IMPROVING”

Reference is now made additionally to FIGS. 16A and 16B, whichillustrates the operation of the system and methodology of the system ofthe present invention in the context of FIG. 15. FIGS. 16A and 16Billustrate the utility of using the capnograph in both diagnostic andmonitoring modes as an aid to diagnosis and monitoring-respectively.

The patient in the hospital environment, preferably attached to amulti-parameter monitor including capnograph 272 and the suitableinstrumentation, by means of cannula 270 and preferably also by means ofchest electrodes 274, finger sensor 276, forehead/scalp sensor 278 andblood pressure cuff 280, is monitored continuously. The neurologicalstatus of the patient is acquired by any suitable technique. Values ofCO₂ concentration, ECG, NIBP and SPO₂ are continuously measured,typically over a period of 30 seconds, and carbon dioxide waveforms arepreferably digitized as a capnogram and other waveforms and stored oncomputer 284.

In the above exemplified scenario (FIG. 15), the medical team initiallydo not know whether the patient's symptoms are indicative of abreathing-related medical problem, such as emphysema, or from a heartrelated medical problem, such as heart failure. The followingmethodology assists and enables the medical team to reach the correctdiagnosis. In contrast, in FIG. 11 above, here were no indications thatthe patient's diagnosis could include a heart-related episode.

Thereafter, the onset and offset limits of the capnogram, the pulsewaveform and QRS onset and offset are determined by computer 284. Theinitial slope of the capnogram and the run are determined and stored incomputer 284.

At a startup stage, computer 284 checks to verify that a valid signal isreceived from capnograph 272. In a case where the signal is indicativeof there being obstructive lung disease, due to the sluggish run timefor example or an acute angled initial slope, then the mode ofmonitoring on capnograph 272 is shifted to its bronchospastic monitoringmode.

In a monitoring rule stage, the following rule is preferably applied tothe values of the end tidal value of exhaled carbon dioxide:

1) If:

-   -   a) ETCO₂ is greater than 15 mm Hg;

then,

-   -   computer 284 displays on display 286 “GOOD WAVEFORM QUALITY;        CRITERIA FOR BRONCHOSPASM MET: STARTING MONITORING”.

Thereafter a cycle of alternating I) sampling step (data collection andmeasurement) and II) diagnostic rule application to the previous samplestep I) is initiated.

I) Sampling Step

a) A sample of expired air is taken and conveyed from cannula 270 tocapnograph 272.

b) The carbon dioxide concentration is measured continuously bycapnograph 272 as a capnogram.

c) The capnogram is digitized as waveform and store for analysis bycomputer 284.

d) Computer 284 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The slope and the run are determined by computer 284.

II) Diagnostic Rule Application Step

In a diagnostic rule application step, the following diagnostic rulesare preferably applied to the measured parameters of I) Sampling step bycomputer 284:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 286 shows the message “NO BROCHOSPASM PRESENT.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is greater than or equal to 91% SAT, but less than 95%        SAT; and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 286.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 91% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 286.

At any one of the diagnostic rule application steps, it may be verifiedthat the patient is suffering from bronchospasm. Once bronchospasm isverified, the operator switches capnograph 272 to a serial comparisonmode. The medical team applies the appropriate interventions to thepatient to treat the bronchospasm.

Thereafter, a cycle of alternating I) sampling step (data collection andmeasurement) and II) monitoring rule application step to the previoussample step I) is initiated.

I) Sampling Step

a) A sample of expired air is taken and conveyed from cannula 270 tocapnograph 272.

b) The carbon dioxide concentration is measured continuously bycapnograph 272 as a capnogram.

c) The capnogram is digitized as waveform and store for analysis bycomputer 284.

d) Computer 284 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The slope and the run are determined by computer 284.

II) Monitoring Rule Application Step

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 284: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 284.

1) If:

-   -   a) the difference in the run values is greater than 0.1 sec; and    -   b) the difference in the slope is less than −15 mm Hg/sec;

then,

-   -   computer 284 displays on display 286 “BRONCHOSPASM WORSENING”.

2) If:

-   -   a) the difference in the run values is more negative than −0.1        sec; and    -   b) the difference in the slope is more than +15 mm Hg/sec;

then,

-   -   computer 284 displays on display 286 “BRONCHOSPASM IMPROVING”

3) If:

-   -   a) the difference in the run is more than or equal to −0.1 sec,        but is less than or equal to 0.1 sec; or    -   b) the difference in the slope is more than or equal to −15 mm        Hg/sec and less than or equal to +15 mm Hg/sec;

then,

-   -   computer 284 displays on display 286 “BRONCHOSPASM UNCHANGED”.

The change in patient's vital functional activities, including SPO₂ andETCO₂, over the time interval are calculated by computer 284.

4) If:

-   -   a) the change in SPO₂ is more negative than −5% SAT; or    -   b) the change in the ETCO₂ is more than +5 mm Hg;

then,

-   -   computer 284 displays on display 286 “VITAL SIGNS        DETERIORATING.”

5) If:

-   -   a) the change in SPO₂ is greater than +5% SAT; or    -   b) the change in the ETCO₂ is less than −5 mm Hg;

then,

-   -   computer 284 displays on display 286 “VITAL SIGNS IMPROVING”.

6) If:

-   -   a) the change in SPO₂ is greater than or equal to −5% SAT, but        less than or equal to +5% SAT; or    -   b) the change in the ETCO₂ is more than or equal to −5 mm Hg,        but less than or equal to +5 mm Hg;

then,

-   -   computer 284 displays on display 286 “VITAL SIGNS UNCHANGED.”

Computer 284 preferably combines the results of these monitoring rulesto display an integrated display 286 such as “BRONCHOSPASM WORSENING;VITAL SIGNS UNCHANGED.”

Once the medical interventions have concluded and the patient'sdisposition has been determined, the operator switches the capnographback to its diagnostic mode.

Reference is now made to FIG. 17, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology in a hospital environment, operative for continuouslymonitoring correct tube position in an intubated patient. As seen inFIG. 17, in a hospital environment, various patient physiologicactivities are sensed and measured, including respiratory physiologicactivities, preferably via an oral airway adapter and/or a nasal ornasal/oral cannula 300, such as a Model Nasal FilterLine Adult XS 04461,O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 302, suchas a Microcap®, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 304, a fingersensor 306, a forehead/scalp sensor 308 and a blood pressure cuff 310respectively, may also be sensed and measured by suitableinstrumentation 312.

The outputs of the capnograph 302 and possibly of additionalinstrumentation 312 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 314, having an associateddisplay 316 which typically analyzes the respiration parameter output ofthe capnograph 302 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement, here “ALERT !!! LOSSOF CO2 WAVEFORM” preferably accompanied by a treatment recommendation,here CHECK FOR TUBE DISLODGEMENT”. Following re-intubation, a reviseddiagnostic statement, here “CO2 WAVEFORM RESTORED, TUBE IN TRACHEA”,preferably accompanied by a treatment recommendation, here “SECURE TUBE”appears.

Reference is now made additionally to FIG. 18, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 17.

The patient in the hospital environment, preferably attached to amulti-parameter monitor including capnograph 302 and instrumentation312, by means of cannula 200 and preferably also by means of chestelectrodes 304, finger sensor 306, forehead/scalp sensor 308 and bloodpressure cuff 310, is monitored continuously. The neurological status ofthe patient is acquired by any suitable technique. Expired air iscollected via cannula 300 and is conveyed to the capnograph 302.

Values of CO₂ concentration, ECG, NIBP and SPO₂ are continuouslymeasured, typically over a period of 30 seconds, and carbon dioxidewaveforms are preferably digitized as a capnogram and together withother waveforms are stored on computer 314.

The onset and offset limits of the patient's capnogram from capnograph302 are delineated by computer 314.

The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 1 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

If the quality is unacceptable, further samples are collected until asample of acceptable quality, according to the above two criteria, istaken.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 302.

The following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a display is provided by computer 314 stating “GOOD WAVEFORM,        TUBE IN TRACHEA, CONFIRM AND SECURE TUBE” on display 316.

If the intubation is successful, the operator confirms this, by forexample, entering the relevant code into computer 314, and capnograph302 is then entered into an intubation monitoring mode. The patient ismonitored continuously. Thus, computer 314 displays “MONITORINGINTUBATION” on display 316.

If there is a loss of the signal from capnograph 302, it may beindicative that the cannula tube 300 has slipped away from the patient'strachea. In such a case, the computer preferably displays “ALERT: CHECKFOR TUBE DISLODGEMENT”.

Thereafter a cycle of alternating I) sampling step (data collection andmeasurement) and II) diagnostic rule application to the previous samplestep I) is initiated.

I) Sampling Step

In this sampling step, an exhaled air sample from cannula 300 isperiodically collected, conveyed and measured by capnograph 302. Thecarbon dioxide concentration value is determined continuously bycapnograph 302. Computer 314 digitizes the capnograph signals as awaveform and store the waveform for analysis.

Thereafter, the ETCO₂ value is determined.

II) Diagnostic Rule Application Step.

The following diagnostic rules are applied to each sample:

1) If:

-   -   a) The value of ETCO₂ is greater or equal to 15 mm Hg; and    -   b) There is no loss in the waveform from capnograph 302;

then,

-   -   computer 314 displays “MONITORING TUBE POSITION: NO DISLODGMENT”        on display 316.

2) If:

-   -   a) The value of ETCO₂ is less than or equal to 15 mm Hg; or    -   b) There is a loss in the waveform from capnograph 302;

then,

-   -   computer 314 displays “ALERT: CHECK FOR TUBE DISLODGMENT” on        display 316.

This cycle typically proceeds until the patient monitoring is halted bythe medical team or operator.

Reference is now made to FIG. 19, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology, operative in a hospital environment, for continuouslymonitoring the respiratory status of a spontaneously breathing patientin first operational scenario. As seen in FIG. 19, in a hospitalenvironment, various patient physiologic activities are sensed andmeasured, including respiratory physiologic activities, preferably viaan oral airway adapter and/or a nasal or nasal/oral cannula 330, such asa Model Nasal FilterLine Adult XS 04461, O₂/CO₂ Nasal FilterLine Adult007141, or Smart CapnoLine Adult (Oral/nasal FilterLine) 007414,commercially available from Oridion Ltd., of Jerusalem Israel, typicallycoupled with a capnograph 332, such as a Microcap®, commerciallyavailable from Oridion Ltd., of Jerusalem Israel. Other patientphysiologic activities relating to cardiac function (e.g. ECG), systemicOxygenation (e.g. pulse oximetry), cerebral oxygenation (e.g. cerebraloximetry) and systemic circulation (e.g. NIBP), typically sensed bymeans of chest electrodes 334, a finger sensor 336, a forehead/scalpsensor 338 and a blood pressure cuff 340 respectively, may also besensed and measured by suitable instrumentation 342.

The outputs of the capnograph 332 and possibly of additionalinstrumentation 342 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 344, having an associateddisplay 346 which typically analyzes the respiration parameter output ofthe capnograph 332 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement, here “PATIENTSTABLE—NO CHANGE IN CLINICAL PARAMETERS. If a change occurs in thepatient respiratory status, a diagnostic statement, here “ALERT: MILDBRONCHOSPASM PRESENT” appears on the display 346, indicating to medicalpersonnel that a bronchospastic condition is present. Followingadministration of breathing treatment, an updated diagnostic statementappears, here “GOOD RESPONSE TO TREATMENT, NO BRONCHOSPASM PRESENT”.

Reference is now made additionally to FIG. 20, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 19.

The patient in the hospital environment, preferably attached to amulti-parameter monitor including capnograph 332 and instrumentation342, by means of cannula 330 and preferably also by means of chestelectrodes 334, finger sensor 336, forehead/scalp sensor 338 and bloodpressure cuff 340, is monitored continuously. The neurological status ofthe patient is acquired by any suitable technique. Expired air iscollected via cannula 300 and is conveyed to the capnograph 332.

Values of CO₂ concentration, ECG, NIBP and SPO₂ are continuouslymeasured, typically over a period of 30 seconds, and carbon dioxidewaveforms are preferably digitized as a capnogram and together withother waveforms are stored on computer 344.

The onset and offset limits of the patient's capnogram from capnograph332 are delineated by computer 344.

The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

If the quality is unacceptable, further samples are collected until asample of acceptable quality, according to the above two criteria, istaken.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 332. The slope and run values of the capnogramfrom capnograph 332 are determined by computer 344.

At startup, the following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a display is provided by computer. 344 stating “GOOD WAVEFORM,        QUALITY: MONITORING FOR BRONCHOSPASM”.

If the monitoring is successful, the operator confirms this, by forexample, entering the relevant code into computer 344, and capnograph332 is then entered into a diagnostic monitoring mode. The patient ismonitored continuously by capnograph 332.

Thereafter a cycle of alternating I) sampling step (data collection andmeasurement) and II) diagnostic rule application to the previous samplestep I) is initiated.

I) Sampling Step

a) A sample of expired air is taken and conveyed from cannula 330 tocapnograph 332.

b) The carbon dioxide concentration is measured continuously bycapnograph 332 as a capnogram.

c) The capnogram is digitized as waveform and store for analysis bycomputer 344.

d) Computer 344 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The slope and the run are determined by computer 344.

II) Diagnostic Rule Application Step

In a diagnostic rule application step, the following diagnostic rulesare preferably applied to the measured parameters of I) Sampling step bycomputer 344:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 346 shows the message “NO BRONCHOSPASM PRESENT.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is greater or equal to 91% SAT, but less than 95% SAT;        and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 346. The patient then receives suitable breathing        treatment as is shown in FIG. 19 hereinabove.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 91% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 346.

Reference is now made to FIGS. 21A and 21B, which are simplifiedpictorial illustrations of an automatic medical diagnostic and treatmentsystem and methodology, operative in a hospital environment, forcontinuously monitoring the respiratory status of a spontaneouslybreathing patient in a second clinical scenario. As seen in FIGS. 21Aand 21B, in a hospital environment, various patient physiologicactivities are sensed and measured, including respiratory physiologicactivities, preferably via an oral airway adapter and/or a nasal ornasal/oral cannula 350, such as a Model Nasal FilterLine Adult XS 04461,O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 352, suchas a Microcap®, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 354, a fingersensor 356, a forehead/scalp sensor 358 and a blood pressure cuff 360respectively, may also be sensed and measured by suitableinstrumentation 362.

The outputs of the capnograph 352 and possibly of additionalinstrumentation 362 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 364, having an associateddisplay 366 which typically analyzes the respiration parameter output ofthe capnograph 352 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement, here “PATIENTSTABLE—NO CHANGE IN CLINICAL PARAMETERS. If a change occurs in thepatient respiratory status, a diagnostic statement, here “ALERT: MILDBRONCHOSPASM PRESENT” appears on the display 346, indicating to medicalpersonnel that a bronchospastic condition is present. Followingadministration of breathing treatment, an updated diagnostic statementappears, here “NO RESPONSE TO TREATMENT, MODERATE BRONCHOSPASM PRESENT”.Additional breathing treatment is administered and thereafter an updateddiagnostic statement appears, here “NO RESPONSE TO TREATMENT, SEVEREBRONCHOSPASM PRESENT”, which may prompt the physician to transfer thepatient to the ICU.

Reference is now made additionally to FIGS. 22A-22C, which illustratesthe operation of the system and methodology of the system of the presentinvention in the context of FIGS. 21A and 21B.

The patient in the hospital environment, preferably attached to amulti-parameter monitor including capnograph 352, is monitoredcontinuously for at least 30 seconds. Expired air is collected viacannula 350 and is conveyed to the capnograph 352.

Values of the CO₂ concentration is continuously measured, typically overa period of 30 seconds, and carbon dioxide waveforms are preferablydigitized as a capnogram and together with other waveforms are stored oncomputer 364.

The onset and offset limits of the patient's capnogram from capnograph352 are delineated by computer 364.

The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

If the quality is unacceptable, further samples are collected until asample of acceptable quality, according to the above two criteria, istaken.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 352. The slope and run values of the capnogramfrom capnograph 352 are determined by computer 364.

At startup, the following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a display is provided by computer 364 stating “GOOD WAVEFORM,        QUALITY: MONITORING FOR BRONCHOSPASM”.

If the monitoring is successful, the operator confirms this, by forexample, entering the relevant code into computer 364, and capnograph352 is then entered into a diagnostic monitoring mode. The patient ismonitored continuously by capnograph 352.

Thereafter a cycle of alternating I) sampling step (data collection andmeasurement) and II) diagnostic rule application to the previous samplestep I) is initiated.

I) Sampling Step

a) A sample of expired air is taken and conveyed from cannula 350 tocapnograph 352.

b) The carbon dioxide concentration is measured continuously bycapnograph 352 as a capnogram.

c) The capnogram is digitized as waveform and store for analysis bycomputer 364.

d) Computer 364 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The slope and the run are determined by computer 364.

II) Diagnostic Rule Application Step

In a diagnostic rule application step, the following diagnostic rulesare preferably applied to the measured parameters of I) Sampling step bycomputer 364:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than 45 mm Hg;

then,

-   -   display 366 shows the message “NO BRONCHOSPASM PRESENT.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is greater than or equal to 91% SAT, but less than 95%        SAT; and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM. PRESENT” is displayed on        display 366.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 91% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 366.

At any one of the diagnostic rule application steps, it may be verifiedthat the patient is suffering from bronchospasm. Once bronchospasm isverified, the operator switches capnograph 352 to a serial comparisonmode. The medical team applies the appropriate interventions to thepatient to treat the bronchospasm.

The patient is attached multi-parameter monitor leads andinstrumentation 362, by means of cannula 350 and preferably also bymeans of chest electrodes 354, finger sensor 356, forehead/scalp sensor358 and blood pressure cuff 360, is monitored continuously. Theneurological status of the patient is acquired by any suitabletechnique.

Values of the CO₂ concentration monitored by capnograph 352, and ECG,NIBP, cerebral oximetry and SPO₂ values, monitored by additionalinstrumentation 362 are supplied to computer 364, and are typicallymeasured continuously over a period of 30 seconds, by techniques asdetailed hereinabove. The parameter data may be digitized as waveformsand are further stored for analysis by computer 364. Thereafter, thelimits of the capnogram, the pulse waveform and QRS onset and offset aredetermined by computer 364.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 352. The initial slope of the capnogram and therun, monitored by capnograph 352, are calculated by computer 364.

At startup, the following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a display is provided by computer 344 stating “GOOD WAVEFORM,        QUALITY: MONITORING FOR BRONCHOSPASM”.

If the monitoring is successful, the operator confirms this, by forexample, entering the relevant code into computer 364, and capnograph352 is then entered into a diagnostic monitoring mode. The patient ismonitored continuously by capnograph 352.

Thereafter, a cycle of alternating I) sampling step (data collection andmeasurement) and II) monitoring rule application step to the previoussample step I) is initiated.

I) Sampling Step

a) A sample of expired air is taken and conveyed from cannula 350 tocapnograph 352.

b) The carbon dioxide concentration is measured continuously bycapnograph 352 as a capnogram.

c) The capnogram is digitized as waveform and store for analysis bycomputer 364.

d) Computer 364 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The slope and the run are determined by computer 364.

II) Monitoring Rule Application Step

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 364: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 364.

1) If:

-   -   a) the difference in the run values is greater than +0.1 sec;        and    -   b) the difference in the slope is more negative than −15 mm        Hg/sec;

then,

-   -   computer 364 displays on display 366 “BRONCHOSPASM WORSENING”.

2) If:

-   -   a) the difference in the run values is more negative than −0.1        sec; and    -   b) the difference in the slope is more than +15 mm Hg/sec;

then,

-   -   computer 364 displays on display 366 “BRONCHOSPASM IMPROVING”.

3) If:

-   -   a) the difference in the run values is equal to or greater than        −0.1 sec, but less than or equal to +0.1 sec; or    -   b) the difference in the slope is more than or equal to −15 mm        Hg but less than or equal to +15 mm Hg/sec;

then,

-   -   computer 364 displays on display 366 “BRONCHOSPASM UNCHANGED”.

The change in patient's vital functional activities, including SPO₂ andETCO₂, over the time interval are calculated by computer 364.

4 If:

-   -   a) the decrease in SPO₂ is more than −5% SAT; or    -   b) the increase in the ETCO₂ is more than 5 mm Hg;

then,

-   -   Computer 364 displays on display 366 “VITAL SIGNS        DETERIORATING.”

5) If:

-   -   a) the increase in SPO₂ is more than 5% SAT; or    -   b) the decrease in the ETCO₂ is greater than −5 mm Hg;

then,

-   -   computer 364 displays on display 366 “VITAL SIGNS IMPROVING”.

6) If:

-   -   a) the change in SPO₂ is greater than or equal to −5% SAT but        less than or equal to +5% SAT; or    -   b) the change in the ETCO₂ is more than or equal to −5 mm Hg or        less than or equal to +5 mm Hg;

then,

-   -   computer 364 displays on display 366 “VITAL SIGNS UNCHANGED”.

Computer 364 preferably combines the results of these monitoring rulesto display an integrated display 366 such as “BRONCHOSPASM WORSENING;VITAL SIGNS UNCHANGED.”

Once the medical interventions have concluded and the patient'sdisposition has been determined, the operator switches the capnographback to its diagnostic mode.

Reference is now made to FIGS. 23A and 23B, which are simplifiedpictorial illustrations of an automatic medical diagnostic and treatmentsystem and methodology operative in a physician's office environment fordetecting the presence and severity of bronchospasm, gauging theresponse to treatment and recommending disposition of a spontaneouslybreathing patient in a first clinical scenario. As seen in FIGS. 23A and23B, a child having an asthma attack is brought to a physician's office.Various patient physiologic activities are sensed and measured,including respiratory physiologic activities, preferably via an oralairway adapter and/or a nasal or nasal/oral cannula 400, such as a ModelNasal FilterLine Adult XS 04461, O₂/CO₂ Nasal FilterLine Adult 007141,or Smart CapnoLine Adult (Oral/nasal FilterLine) 007414, commerciallyavailable from Oridion Ltd., of Jerusalem Israel, typically coupled witha capnograph 402, such as a Microcap, commercially available fromOridion Ltd., of Jerusalem Israel. Other patient physiologic activitiesrelating to cardiac function (e.g. ECG), systemic oxygenation (e.g.pulse oximetry), cerebral oxygenation (e.g. cerebral oximetry) andsystemic circulation (e.g. NIBP), typically sensed by means of chestelectrodes 404, a finger sensor 406, a forehead/scalp sensor 408 and ablood pressure cuff 410 respectively, may also be sensed and measured bysuitable instrumentation 412.

The outputs of the capnograph 402 and preferably of additionalinstrumentation 404 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 416 having an associateddisplay 418, which typically analyzes the respiration parameter outputof the capnograph 402 and preferably other physiologic activities andprovides an output which preferably contains a diagnostic statement,here “MODERATE BRONCHOSPASM PRESENT”.

The patient is given breathing treatments, such as beta agonistnebulizer treatments and following such treatments and/or in the coursethereof, the physiologic activities of the patient continue to bemonitored. This monitoring is employed by computer 160 to indicate theresponse to the breathing treatments and the current status of thebronchospasm condition. When the breathing treatments are successful, astatus message, here “GOOD RESPONSE TO TREATMENT”, is presentedaccompanied by a disposition recommendation, here “CONSIDER DISCHARGE TOHOME” and the physician may allow the child to return home after thetreatment.

Reference is now made additionally to FIGS. 24A and 24B, whichillustrate the operation of the system and methodology of the system ofthe present invention in the context of FIGS. 23A and 23B.

The patient in the clinical environment, preferably attached to amulti-parameter monitor including capnograph 402, is monitoredcontinuously for at least 30 seconds. Expired air is collected viacannula 400 and is conveyed to the capnograph 402.

Values of the CO₂ concentration is continuously measured, typically overa period of 30 seconds, and carbon dioxide waveforms are preferablydigitized as a capnogram and together with other waveforms are stored oncomputer 416.

The onset and offset limits of the patient's capnogram from capnograph402 are delineated by computer 416.

The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

If the quality is unacceptable, further samples are collected until asample of acceptable quality, according to the above two criteria, istaken.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 402. The slope and run values of the capnogramfrom capnograph 402 are determined by computer 416.

At startup, the following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a display is provided by computer 416 stating “GOOD WAVEFORM,        QUALITY: MONITORING FOR BRONCHOSPASM”.

If the monitoring is successful, the operator confirms this, by forexample, entering the relevant code into computer 416, and capnograph402 is then entered into a diagnostic monitoring mode. The patient ismonitored continuously by capnograph 402.

Thereafter a cycle of alternating I) sampling step (data collection andmeasurement) and II) diagnostic rule application to the previous samplestep is initiated. The sampling step is typically performed every 15minutes for one hour after the treatment.

I) Sampling Step

a) A sample of expired air is taken and conveyed from cannula 400 tocapnograph 402.

b) The carbon dioxide concentration is measured continuously bycapnograph 402 as a capnogram 417.

c) The capnogram is digitized as waveform and store for analysis bycomputer 416.

d) Computer 416 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The slope and the run are determined by computer 416.

II) Diagnostic Rule Application Step

In a diagnostic rule application step, the following diagnostic rulesare preferably applied to the measured parameters of I) Sampling step bycomputer 416:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 418 shows the message “NO BRONCHOSPASM PRESENT.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is more than or equal to 91% SAT, but less than 95% SAT;        and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 418.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 91% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 418.

At any one of the diagnostic rule application steps, it may be verifiedthat the patient is suffering from bronchospasm. Once bronchospasm isverified, the operator switches capnograph 402 to a serial comparisonmode. The medical team applies the appropriate interventions to thepatient to treat the bronchospasm.

The following rule is preferably applied to the capnogram by computer416:

1) If:

-   -   a) the value of CAP-FEV1 is greater than 50%; and    -   b) the slope is greater or equal to 100 mm Hg/sec; and,    -   c) the angle of rise of the carbon dioxide concentration is        greater than a predetermined value in degrees

then,

-   -   computer 416 displays a message on display 418: “GOOD RESPONSE        TO TREATMENT: CONSIDER DISCHARGE HOME.”

Reference is now made to FIGS. 25A and 25B, which are simplifiedpictorial illustrations of an automatic medical diagnostic and treatmentsystem and methodology operative in a physician's office environment fordetecting the presence and severity of bronchospasm, gauging theresponse to treatment and recommending disposition of a spontaneouslybreathing patient in a second clinical scenario. As seen in FIGS. 25Aand 25B, a child having an asthma attack is brought to a physician'soffice. Various patient physiologic activities are sensed and measured,including respiratory physiologic activities, preferably via an oralairway adapter and/or a nasal or nasal/oral cannula 420, such as a ModelNasal FilterLine Adult XS 04461, O₂/CO₂ Nasal FilterLine Adult 007141,or Smart CapnoLine Adult (Oral/nasal FilterLine) 007414, commerciallyavailable from Oridion Ltd., of Jerusalem Israel, typically coupled witha capnograph 422, such as a Microcap, commercially available fromOridion Ltd., of Jerusalem Israel. Other patient physiologicalactivities relating to cardiac function (e.g. ECG), systemic oxygenation(e.g. pulse oximetry), cerebral oxygenation (e.g. cerebral oximetry) andsystemic circulation (e.g. NIBP), typically sensed by means of chestelectrodes 424, a finger sensor 426, a forehead/scalp sensor 428 and ablood pressure cuff 430 respectively, may also be sensed and measured bysuitable instrumentation 432.

The outputs of the capnograph 422 and preferably of additionalinstrumentation 424 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 426 having an associateddisplay 428, which typically analyzes the respiration parameter outputof the capnograph 422 and preferably other physiologic activities andprovides an output which preferably contains a diagnostic statement,here “MODERATE BRONCHOSPASM PRESENT”.

The patient is given breathing treatments, such as beta agonistnebulizer treatments and following such treatments and/or in the coursethereof, the physiologic activities of the patient continue to bemonitored. This monitoring is employed by computer 426 to indicate theresponse to the breathing treatments and the current status of thebronchospasm condition. When the breathing treatments are notsuccessful, a status message, here “POOR RESPONSE TO TREATMENT”, ispresented accompanied by a disposition recommendation, here “CONSIDERADMISSION TO HOSPITAL” and the physician may send the child to thehospital.

Reference is now made additionally to FIGS. 26A and 26B, whichillustrate the operation of the system and methodology of the system ofthe present invention in the context of FIGS. 25A and 25B.

The patient in the clinical environment, preferably attached to amulti-parameter monitor including capnograph 422, is monitoredcontinuously for at least 30 seconds. Expired air is collected viacannula 420 and is conveyed to the capnograph 422.

Values of the CO₂ concentration is continuously measured, typically overa period of 30 seconds, and carbon dioxide waveforms are preferablydigitized as a capnogram and together with other waveforms are stored oncomputer 426.

The onset and offset limits of the patient's capnogram from capnograph422 are delineated by computer 426.

The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

If the quality is unacceptable, further samples are collected until asample of acceptable quality, according to the above two criteria, istaken.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 422. The slope and run values of the capnogramfrom capnograph 422 are determined by computer 426.

At startup, the following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a display is provided by computer 426 stating “GOOD WAVEFORM,        QUALITY: MONITORING FOR BRONCHOSPASM”.

If the monitoring is successful, the operator confirms this, by forexample, entering the relevant code into computer 426, and capnograph422 is then entered into a diagnostic monitoring mode. The patient ismonitored continuously by capnograph 422.

Thereafter a cycle of alternating I) sampling step (data collection andmeasurement) and II) diagnostic rule application to the previous samplestep I) is initiated. The sampling step is typically performed every 15minutes for one hour after the treatment.

I) Sampling Step

a) A sample of expired air is taken and conveyed from cannula 420 tocapnograph 422.

b) The carbon dioxide concentration is measured continuously bycapnograph 422 as a capnogram.

c) The capnogram is digitized as waveform and store for analysis bycomputer 426.

d) Computer 426 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The slope and the run are determined by computer 426.

II) Diagnostic Rule Application Step

In a diagnostic rule application step, the following diagnostic rulesare preferably applied to the measured parameters of I) Sampling step bycomputer 426:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 428 shows the message “NO BRONCHOSPASM PRESENT.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is greater than or equal to 91% SAT, but less than 95%        SAT; and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 428.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 91% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 428.

At any one of the diagnostic rule application steps, it may be verifiedthat the patient is suffering from bronchospasm. Once bronchospasm isverified, the operator switches capnograph 422 to a serial comparisonmode. The medical team applies the appropriate interventions to thepatient to treat the bronchospasm.

The following rule is preferably applied to the capnogram by computer426:

1) If:

-   -   a) the value of CAP-FEV 1 is less than 50%; and    -   b) the slope is less than 100 mm Hg/sec; and,    -   c) the angle of rise of the carbon dioxide concentration is less        than a predetermined value in degrees;

then,

-   -   computer 426 displays a message on display 428: “POOR RESPONSE        TO TREATMENT: CONSIDER ADMISSION TO HOSPITAL INTENSIVE CARE.”

Reference is now made to FIGS. 27A and 27B, which are simplifiedpictorial illustrations of an automatic medical diagnostic and treatmentsystem and methodology in an ambulance environment for detecting thepresence and severity of bronchospasm from an allergic reaction, gaugingthe response to treatment and recommending disposition. As seen in FIGS.27A and 27B, a child complains of difficulty breathing. The parentsummons an ambulance and similarly to that described hereinabove withreference to FIG. 9, in an ambulance environment various patientphysiologic activities are sensed and measured, including respiratoryphysiologic activities, preferably via an oral airway adapter and/or anasal or nasal/oral cannula 450, such as a Model Nasal FilterLine AdultXS 04461, O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 452, suchas a Microcap, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 454, a fingersensor 456, a forehead/scalp sensor 458 and a blood pressure cuff 460respectively, may also be sensed and measured by suitableinstrumentation 462. Other patient physiologic activities relating tocardiac function (e.g. ECG), cerebral perfusion (e.g. CEREBRALOXIMETRY), oxygenation (e.g. pulse oximetry) and systemic circulation(e.g. NIBP), may also be sensed and measured by suitable instrumentation462.

The outputs of the capnograph 452 and preferably of additionalinstrumentation 462 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 464 having an associateddisplay 466, which typically analyzes the respiration parameter outputof the capnograph 452 and preferably other physiologic activities andprovides an output which preferably contains a diagnostic statementindicating the presence of lower airway obstruction, here “ALERT:MODERATE BRONCHOSPASM PRESENT”. The presence of bronchospasmdefinitively indicates lower airway obstruction.

The patient is given breathing treatment, such as a beta agonistnebulizer treatment and following such treatment and/or in the coursethereof, the physiologic activities of the patient continue to bemonitored. This monitoring is employed by computer 464 to indicate theresponse to the breathing treatment and the current status of thepatient condition. In the scenario of FIGS. 14A and 14B, the patientfails to respond sufficiently to the breathing treatment and this isindicated by a status change statement, here “POOR RESPONSE TOTREATMENT, CONDITION CRITICAL”. A treatment recommendation may also beprovided, such as “CONSIDER INTUBATION”.

Intubation is performed and correct initial tube placement is confirmedfollowed by continuous monitoring of the physiologic activities of thepatient, which indicate current tube position. In this scenario, whereintubation is successful, a status statement, here: “ADEQUATE CO₂WAVEFORM—TUBE IN TRACHEA” and a treatment recommendation, here “SECURETUBE” appear.

Following successful intubation, continuous monitoring may provide astatus statement such as “ADEQUATE CO₂ WAVEFORM—TUBE IN TRACHEA—NODISLOGEMENT”. If tube dislodgment occurs at any time followingintubation, a status statement would appear, such as “CO₂ WAVEFORMABSENT” preferably accompanied by a treatment recommendation, such as“CHECK FOR TUBE DISLOGEMENT”.

Preferably some or all of the outputs of computer 464 are transmitted ina wireless manner by a transmitter 468, such as via radio or a cellulartelephone link, preferably to a dispatch center or patient receivingfacility.

Reference is now made additionally to FIG. 28, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIGS. 27A and 27B. FIG. 28 illustrates anexample of the system and methodology applied to assessing whether apatient has an upper or lower airway obstruction, in the duration of thepatient being transferred by ambulance.

In the scenario described in FIGS. 27A and 27B hereinabove, it ispresumed that the patient may be having an allergic reaction. Theoperator switches capnograph 452 into an assessing mode so as to enablean assessment to be made whether and if the patient has an upper or alower airway disorder.

The patient previously attached to a multi-parameter monitor including acapnograph 452 and suitable instrumentation 462, by means of cannula 450and preferably also by means of chest electrodes 454, finger sensor 456,forehead sensor 458 and blood pressure cuff 460, is monitoredcontinuously for at least thirty seconds. Neurological status of thepatient is acquired by any suitable technique, including visual andelectroencephalograph (EEG) monitoring. Values of CO₂ concentration,ECG, NIBP and (the percent saturation of the hemoglobin molecule withoxygen) SPO₂ are continuously monitored, and carbon dioxide waveformsare preferably digitized as a capnogram 452 and together with otherwaveforms are stored in computer 464.

At least one expired air sample is collected and conveyed for analysisby capnograph 452. The outputs of the capnograph 452 and possibly ofadditional instrumentation 462 are preferably supplied to suitablyprogrammed automatic diagnostic and treatment computer 464, havingassociated display 466, which typically analyzes the respirationparameter output of the capnograph 452.

In an analyzing step, the onset and offset limits of a capnogram 469,pulse waveforms, and the QRS complex (of the ECG) are marked by computer464. The actual parameters measured include, but are not limited toheart rate (HR), BP, the systolic to diastolic ratio (SYS/DIA). SPO₂,AND ETCO₂. The slope of CO₂ (mm Hg/sec), and CO₂ “run”, of the capnogram469, measured to 80% of maximum CO₂ concentration, are calculated bycomputer 464.

Following each treatment, the differences between consecutivemeasurements of the various patient parameters are computed by computer464. Thereafter, in a diagnostic rule application step, the followingdiagnostic rules are preferably applied to the measured parameters bycomputer 464:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal; and    -   c) ETCO₂ is less than 45 mm Hg;

then,

-   -   display 466 shows the message “VITAL SIGNS STABLE”.

2) In contrast, if:

1) If:

-   -   a) the blood pressure values are not within the normal range;    -   b) the respiratory rate is not normal; and    -   c) ETCO₂ is more than or equal to 45 mm Hg;

then,

-   -   display 466 shows the message “RESPIRATORY IMPAIRMENT”.

Additionally, the following rules may also be applied:

3) If:

-   -   a) CO₂ run is less than or equal to 0.3 sec; and    -   b) CO₂ slope is more than or equal to 100 mm Hg/sec;

then,

-   -   display 466 shows the message “NO BRONCHOSPASM PRESENT: CONSIDER        UPPER AIRWAY OBSTRUCTION”.

4) If:

-   -   a) CO₂ run is more than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;

then,

-   -   display 466 shows the message “BRONCHOSPASM PRESENT: CONSIDER        LOWER AIRWAY OBSTRUCTION”.

The findings of the last stage are stored by computer 464 and/ortransmitted via transmitter 468 to a dispatch/receiving center,typically located at a hospital or medical center. A connection isestablished with the dispatch/receiving center, and the data isforwarded thereto. A medical supervisor typically watches display of thereceived data, and consequentially transmits the recommended treatmentand/or transport recommendations back to the ambulance.

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 464: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 464.

1) If:

-   -   a) the difference in the run values is greater than +0.1 sec;        and    -   b) the difference in the slope is more negative than −15 mm        Hg/sec;

then,

-   -   computer 464 displays on display 466 “BRONCHOSPASM WORSENING”.

2) If:

-   -   a) the difference in the run values is more negative than −0.1        sec; and    -   b) the difference in the slope is more positive than +15 mm        Hg/sec;

then,

-   -   computer 464 displays on display 466 “BRONCHOSPASM IMPROVING”.

3) If:

-   -   a) the difference in the run is greater or equal to −0.1 sec,        but less than or equal to +0.1 sec; or    -   b) the difference in the slope is more than or equal to −15 mm        Hg/sec and less than or equal to +15 mm Hg/sec;

then,

-   -   computer 464 displays on display 466 “BRONCHOSPASM UNCHANGED”.

The change in patient's vital functional activities, including SPO₂ andETCO₂, over the time interval are calculated by computer 464.

4) If:

-   -   a) the decrease in SPO₂ is more negative than −5% SAT; or    -   b) the increase in the ETCO₂ is more than +5 mm Hg;

then,

-   -   computer 184 displays on display 186 “VITAL SIGNS        DETERIORATING.”

5) If:

-   -   a) the increase in SPO₂ is more than +5% SAT; or    -   b) the decrease in the ETCO₂ is more than −5 mm Hg;

then,

-   -   computer 464 displays on display 466 “VITAL SIGNS IMPROVING”.

6) If:

-   -   a) the change in SPO₃ is greater than or equal to −5% SAT, but        less than or equal to +5% SAT; or    -   b) the change in the ETCO₂ is more than or equal to −5 mm Hg,        but less than or equal to +5 mm Hg;

then,

-   -   computer 464 displays on display 466 “VITAL SIGNS UNCHANGED.”

Computer 464 preferably combines the results of these monitoring rulesto display an integrated display 466 such as “BRONCHOSPASM WORSENING;VITAL SIGNS UNCHANGED.”

In a checking rule step, the following rule is preferably applied:

1) A patient appears to be entering respiratory failure phase if:

-   -   a) the SPO₂ is less than 90% SAT;    -   b) the respiratory rate is less than 8/min;    -   c) ETCO₂ is greater than 60 mm Hg; and    -   d) the patient's neurological symptoms are qualified as being        “bad”;

then,

-   -   computer 464 displays “RESPIRATORY FAILURE; CONDITION CRITICAL;        CONSIDER INTUBATION.” on display 466.

Following this, in an alert data transmission stage, a high priorityupdate is transmitted via transmitter 468 from computer 464 to notifythe dispatch/receiving centers of the significant deterioration andchange in the patient's condition.

Once these changes in the patient's condition have been confirmed by anoperator, the patient is consequentially intubated according to standardtechniques and capnograph 452 is activated in intubation monitoring modeby computer 464. Once the successful intubation of the patient isverified by data comparison of the patient's capnogram and standardizedcapnograms for intubation in computer 464, the computer displays“MONITORING FOR INTUBATION”.

Thereafter, the following check rule is preferably applied to thepatient's capnogram:

1. If:

-   -   a) ETCO₂ is greater than 15 mm Hg;

then,

-   -   computer 464 displays “GOOD WAVEFORM, TUBE IN TRACHEA. CONFIRM        AND SECURE TUBE.”

In the next step, the following monitoring rules are preferably appliedto the patient's capnogram:

1) If:

-   -   a) the value of ETCO₂ is greater than 15 mm Hg;

then,

-   -   computer 214 displays “MONITORING TUBE POSITION: NO        DISLODGEMENT” on display 216.

2) If:

-   -   a) the value of ETCO₂ is less than or equal to 15 mm Hg; or    -   b) there is a loss of the waveform;

then,

-   -   computer 464 displays “ALERT: CHECK FOR TUBE DISLODGEMENT” on        display 466.

Computer 464 transmits the data monitored via transmitter 468 to thereceiving center. The receiving center periodically receives updates ofthe patient's condition, who is in the ambulance en route to thehospital, in order to prepare in the most fitting and efficient transferof the patient upon arrival to the hospital.

A copy of the patient's record is handed off from computer 464 viatransmitter 468 to the receiving center, for example, in the form of achart. Typically, the receiving center stores this chart, so that it maybe used as a baseline for continued monitoring of the patient.

Reference is now made to FIG. 29, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology in an ambulance environment for distinguishing between upperairway obstruction and lower airway obstruction, such as distinguishingbetween asthma and croup, bronchiolitis and croup, and allergicreactions affecting the upper or lower airways. As seen in FIG. 29, aperson complains of difficulty breathing. An ambulance is summoned andsimilarly to that described hereinabove with reference to FIG. 17, in anambulance environment various patient physiologic activities are sensedand measured, including respiratory physiologic activities, preferablyvia an oral airway adapter and/or a nasal or nasal/oral cannula 470,such as a Model Nasal FilterLine Adult XS 04461, O₂/CO₂ Nasal FilterLineAdult 007141, or Smart CapnoLine Adult (Oral/nasal FilterLine) 007414,commercially available from Oridion Ltd., of Jerusalem Israel, typicallycoupled with a capnograph 472, such as a Microcap, commerciallyavailable from Oridion Ltd., of Jerusalem Israel. Other patientphysiologic activities relating to cardiac function (e.g. ECG), systemicoxygenation (e.g. pulse oximetry), cerebral oxygenation (e.g. cerebraloximetry) and systemic circulation (e.g. NIBP), typically sensed bymeans of chest electrodes 474, a finger sensor 476, a forehead/scalpsensor 478 and a blood pressure cuff 480 respectively, may also besensed and measured by suitable instrumentation 482. Other patientphysiologic activities relating to cardiac function (e.g. ECG), cerebralperfusion (e.g. CEREBRAL OXIMETRY), oxygenation (e.g. pulse oximetry)and systemic circulation (e.g. NIBP), may also be sensed and measured bysuitable instrumentation 482.

The outputs of the capnograph 472 and preferably of additionalinstrumentation 482 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 484 having an associateddisplay 486, which typically analyzes the respiration parameter outputof the capnograph 472 and preferably other physiologic activities andprovides an output which preferably contains a diagnostic statementdifferentiating upper airway obstruction from lower airway obstruction,here “ELEVATED RESPIRATORY RATE. NO BRONCHOSPASM PRESENT”. The absenceof bronchospasm in this scenario strongly suggests upper airwayobstruction.

The patient is given an intravenous or intra-muscular medication, suchas adrenaline, and following such treatment and/or in the coursethereof, the physiologic activities of the patient continue to bemonitored. This monitoring is employed by computer 484 to indicate theresponse to the treatment and the current status of the patientcondition. In the scenario of FIG. 29, the patient responds to thetreatment and this is indicated by a status change statement, here“CONDITION STABLE”. Preferably some or all of the outputs of computer484 are transmitted in a wireless manner by a transmitter 488, such asvia radio or a cellular telephone link, preferably to a dispatch centeror patient receiving facility.

Reference is now made additionally to FIG. 30, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 29. The patient is treated in anambulance environment as is described hereinabove in FIG. 29; and thepatient is being assessed to see whether his/her upper or lower airwayis obstructed. The methodology illustrates the case where an upperobstruction is found.

In the scenario described in FIG. 29 hereinabove, it is presumed thatthe patient may be having an allergic reaction. The operator switchescapnograph 452 into an assessing mode so as to enable an assessment tobe made whether and if the patient has an upper or a lower airwaydisorder.

The patient previously attached to a multi-parameter monitor including acapnograph 472 and suitable instrumentation 482, by means of cannula 470and preferably also by means of chest electrodes 474, finger sensor 476,forehead sensor 478 and blood pressure cuff 480, is monitoredcontinuously for at least thirty seconds. Neurological status of thepatient is acquired by any suitable technique, including visual andelectroencephalograph (EEG) monitoring. Values of CO₂ concentration,ECG, NIBP and SPO₂ are continuously monitored, and carbon dioxidewaveforms are preferably digitized as a capnogram 472 and together withother waveforms are stored in computer 484.

At least one expired air sample is collected and conveyed for analysisby capnograph 472. The outputs of the capnograph 472 and possibly ofadditional instrumentation 482 are preferably supplied to suitablyprogrammed automatic diagnostic and treatment computer 484, havingassociated display 486, which typically analyzes the respirationparameter output of the capnograph 472.

In an analyzing step, the onset and offset limits of a capnogram 489,pulse waveforms, and the QRS complex (of the ECG) are marked by computer484. The actual parameters measured include, but are not limited toheart rate (HR), BP, the systolic to diastolic ratio (SYS/DIA). SPO₂,AND ETCO₂. The slope of CO₂ (mm Hg/sec), and CO₂ “run”, of the capnogram489, measured to 80% of maximum CO₂ concentration, are calculated bycomputer 484.

Following each treatment, the differences between consecutivemeasurements of the various patient parameters are computed by computer484. Thereafter, in a diagnostic rule application step, the followingdiagnostic rules are preferably applied to the measured parameters bycomputer 484:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal; and    -   c) ETCO₂ is less than 45 mm Hg;

then,

-   -   display 486 shows the message “VITAL SIGNS STABLE”.

2) In contrast, if:

1) If:

-   -   a) the blood pressure values are not within the normal range;    -   b) the respiratory rate is not normal; and    -   c) ETCO₂ is more than or equal to 45 mm Hg;

then,

-   -   display 486 shows the message “RESPIRATORY IMPAIRMENT”.

Additionally, the following rules may also be applied:

3) If:

-   -   a) CO₂ run is less than 0.3 sec;    -   b) CO₂ slope is more than 100 mm Hg/sec;

then,

-   -   display 486 shows the message “NO BRONCHOSPASM PRESENT”.

4) If:

-   -   a) CO₂ run is more than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;

then,

-   -   display 486 shows the message “BRONCHOSPASM PRESENT: CONSIDER        LOWER AIRWAY OBSTRUCTION”.

The findings of the last stage are stored by computer 484 and/ortransmitted via transmitter 488 to a dispatch/receiving center,typically located at a hospital or medical center. A connection isestablished with the dispatch/receiving center, and the data isforwarded thereto. A medical supervisor typically watches display of thereceived data, and consequentially transmits the recommended treatmentand/or transport recommendations back to the ambulance.

A copy of the patient's record is handed off from computer 464 viatransmitter 488 to the receiving center, for example, in the form of achart. Typically, the receiving center stores this chart, so that it maybe used as a baseline for continued monitoring of the patient.

Reference is now made to FIG. 31, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology for distinguishing between heart failure and emphysema in ascenario in which heart failure is present. As seen in FIG. 31, variouspatient physiologic activities are sensed and measured, includingrespiratory physiologic activities, preferably via an oral airwayadapter and/or a nasal or nasal/oral cannula 500, such as a Model NasalFilterLine Adult XS 04461, O₂/CO₂Nasal FilterLine Adult 007141, or SmartCapnoLine Adult (Oral/nasal. FilterLine) 007414, commercially availablefrom Oridion Ltd., of Jerusalem Israel, typically coupled with acapnograph 502, such as a Microcap®, commercially available from OridionLtd., of Jerusalem Israel. Other patient physiologic activities relatingto cardiac function (e.g. ECG), systemic oxygenation (e.g. pulseoximetry), cerebral oxygenation (e.g. cerebral oximetry) and systemiccirculation (e.g. NIBP), typically sensed by means of chest electrodes504, a finger sensor 506, a forehead/scalp sensor 508 and a bloodpressure cuff 510 respectively, may also be sensed and measured bysuitable instrumentation 512.

The outputs of the capnograph 502 and possibly of additionalinstrumentation 512 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 514, having an associateddisplay 516 which typically analyzes the respiration parameter output ofthe capnograph 517 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement differentiating heartfailure from emphysema, here “ABNORMAL CO₂ WAVEFORM CONSISTENT WITHMODERATE CONGESTIVE HEART FAILURE”.

This diagnostic statement indicates that treatment is required for heartfailure rather than for emphysema. Intravenous and/or sublingualmedications such as nitroglycerin, morphine and LASIX® are administeredafter which a diagnostic statement which indicates the patient statusand the severity of the cardio-respiratory condition is preferablypresented, here “MILD CONGESTIVE HEART FAILURE, CONDITION IMPROVING”

Reference is now made additionally to FIGS. 32A and 32B, whichillustrate the operation of the system and methodology of the system ofthe present invention in the context of FIG. 31. The patient is treatedin an ambulance environment as is described hereinabove in FIG. 15, andthe patient is being assessed to see whether his/her upper or lowerairway is obstructed. The methodology illustrates the case where anupper obstruction is found.

In the scenario described in FIG. 31 hereinabove, it is presumed thatthe patient may be suffering from either emphysema or a heart failure inan ambulance. It is shown hereinbelow how the patient is diagnosed ashaving a heart failure.

The patient, previously attached to a multi-parameter monitor includinga capnograph 502 and suitable instrumentation 512, by means of cannula500 and preferably also by means of chest electrodes 504, finger sensor506, forehead sensor 508 and blood pressure cuff 510, is monitoredcontinuously for at least thirty seconds. Neurological status of thepatient is acquired by any suitable technique, including visual andelectroencephalograph (EEG) monitoring. Values of CO₂ concentration,ECG, NIBP and SPO₂ are continuously monitored, and carbon dioxidewaveforms are preferably digitized as a capnogram 517 and together withother waveforms are stored in computer 514.

At least one expired air sample is collected and conveyed for analysisby capnograph 472. The outputs of the capnograph 502 and possibly ofadditional instrumentation 512 are preferably supplied to suitablyprogrammed automatic diagnostic and treatment computer 514, havingassociated display 516, which typically analyzes the respirationparameter output of the capnograph 502.

In an analyzing step, the onset and offset limits of a capnogram 517,pulse waveforms, and the QRS complex (of the ECG) are marked by computer514. The actual parameters measured include, but are not limited toheart rate (HR), BP, the systolic to diastolic ratio (SYS/DIA). SPO₂,AND ETCO₂. The slope of CO₂ (mm Hg/sec), and CO₂ “run”, of the capnogram517, measured to 80% of maximum CO₂ concentration, are calculated bycomputer 514.

Following each treatment, the differences between consecutivemeasurements of the various patient parameters are computed by computer514. Thereafter, in a diagnostic rule application step, the followingdiagnostic rules are preferably applied to the measured parameters bycomputer 514:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal; and    -   c) ETCO₂ is less than 45 mm Hg;

then,

-   -   display 516 shows the message “VITAL SIGNS WITHIN NORMAL        LIMITS”.

2) In contrast, if:

-   -   a) the value of Diminished CAP-FEV1 is a 40:10 point ratio; and,    -   b) Normal CAP-FEV1/FVC (FORCED VITAL CAPACITY);    -   c) CO₂ run is less than 0.3 sec;    -   d) CO₂ slope is more than 100 mm Hg/sec;

then,

-   -   display 516 shows the message “HEART FAILURE PRESENT”.

Additionally, if a heart failure is present then the following rules mayalso be applied:

3) If:

-   -   a) the value of CAP-FEV1 is less than 80%;

then

-   -   display 516 shows the message “MODERATE HEART FAILURE PRESENT”.    -   4) If:    -   a) the value of CAP-FEV1 is less than 80%;    -   b) the value of SPO₂ is less than 91% SAT; and    -   c) the value of ETCO₂ is less than 45 mm Hg;

then,

-   -   display 516 shows the message “SEVERE HEART FAILURE PRESENT”.

Thereafter a cycle of alternating I) sampling step (data collection andmeasurement) and II) diagnostic rule application to the previous samplestep I) is initiated.

I) Sampling Step

a) A sample of expired air is taken and conveyed from cannula 500 tocapnograph 502.

b) The carbon dioxide concentration is measured continuously bycapnograph 502 as capnogram 517.

c) The capnogram is digitized as waveform and store for analysis bycomputer 514.

d) Computer 514 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The slope and the run are determined by computer 514.

II) Diagnostic Rule Application Step

In a diagnostic rule application step, the following diagnostic rulesare preferably applied to the measured parameters of I) Sampling step bycomputer 514:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 516 shows the message “NO HEART FAILURE PRESENT.”

2) If:

-   -   a) the value of CAP-FEV1 is more than 50%, but less than or        equal to 80%; and    -   b) the value of SPO₂ is greater or equal to 91% SAT but less        than 95% SAT;

then

-   -   display 516 shows the message “MODERATE HEART FAILURE        PRESENT”. 3) If:    -   a) the value of CAP-FEV1 is less than 80%;    -   b) the value of SPO₂ is less than 91% SAT; and    -   c) the value of ETCO₂ is less than 45 mm Hg;

then,

-   -   display 516 shows the message “SEVERE HEART FAILURE PRESENT”.

Reference is now made to FIG. 33, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology operative in an ambulance environment for treating pulmonaryedema. As seen in FIG. 33, various patient physiologic activities aresensed and measured, including respiratory physiologic activities,preferably via an oral airway adapter and/or a nasal or nasal/oralcannula 550, such as a Model Nasal FilterLine Adult XS 04461, O₂/CO₂Nasal FilterLine Adult 007141, or Smart CapnoLine Adult (Oral/nasalFilterLine) 007414, commercially available from Oridion Ltd., ofJerusalem Israel, typically coupled with a capnograph 552, such as aMicrocap, commercially available from Oridion Ltd., of Jerusalem Israel.Other patient physiologic activities relating to cardiac function (e.g.ECG), systemic oxygenation (e.g. pulse oximetry), cerebral oxygenation(e.g. cerebral oximetry) and systemic circulation (e.g. NIBP), typicallysensed by means of chest electrodes 554, a finger sensor 556, aforehead/scalp sensor 558 and a blood pressure cuff 560 respectively,may also be sensed and measured by suitable instrumentation 562.

The outputs of the capnograph 552 and possibly of additionalinstrumentation 562 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 564, having an associateddisplay 566 which typically analyzes the respiration parameter output ofthe capnograph 552 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement indicating the presenceand severity of congestive heart failure, here “ABNORMAL CO₂ WAVEFORMCONSISTENT WITH SEVERE CONGESTIVE HEART FAILURE”.

This diagnostic statement indicates that treatment is required for heartfailure. Intravenous and/or sublingual medications such asnitroglycerin, morphine and LASIX R are administered after which adiagnostic, statement which indicates the patient status and theseverity of the cardio-respiratory condition is preferably presented,here “MODERATE CONGESTIVE HEART FAILURE, CONDITION IMPROVING”.

Reference is now made additionally to FIGS. 34A and 34B, whichillustrate the operation of the system and methodology of the system ofthe present invention in the context of FIG. 33.

The patient previously attached to a multi-parameter monitor including acapnograph 552 and suitable instrumentation 562, by means of cannula 550and preferably also by means of chest electrodes 554, finger sensor 556,forehead sensor 558 and blood pressure cuff 560, is monitoredcontinuously for at least thirty seconds. Neurological status of thepatient is acquired by any suitable technique, including visual andelectroencephalograph (EEG) monitoring. Values of CO₂ concentration,ECG, NIBP, SPO₂, and cerebral oximetry are continuously monitored, andcarbon dioxide waveforms are preferably digitized as a capnogram 567 andtogether with other waveforms are stored in computer 564.

At least one expired air sample is collected and conveyed for analysisby capnograph 552. The outputs of the capnograph 552 and possibly ofadditional instrumentation 562 are preferably supplied to suitablyprogrammed automatic diagnostic and treatment computer 564, havingassociated display 566, which typically analyzes the respirationparameter output of the capnograph 552.

In an analyzing step, the onset and offset limits of a capnogram 567,pulse waveforms, and the QRS complex (of the ECG) are marked by computer564. The actual parameters measured include, but are not limited toheart rate (HR), BP, the systolic to diastolic ratio (SYS/DIA). SPO₂,AND ETCO₂. The slope of CO₂ (mm Hg/sec), and CO₂ “run”, of the capnogram567, measured to 80% of maximum CO₂ concentration, are calculated bycomputer 564.

Following each treatment, the differences between consecutivemeasurements of the various patient parameters are computed by computer564. Thereafter, in a diagnostic rule application step, the followingdiagnostic rules are preferably applied to the measured parameters bycomputer 564:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal; and    -   c) ETCO₂ is less than 45 mm Hg;

then,

-   -   display 566 shows the message “VITAL SIGNS WITHIN NORMAL        LIMITS”.

2) In contrast, if:

-   -   a) the value of Diminished CAP-FEV1 is a 40:10 point ratio;    -   b) Normal CAP-FEV/FVC;    -   c) CO₂ run is less than 0.3 sec; and,    -   d) CO₂ slope is more than 100 mm Hg/sec;

then,

-   -   display 566 shows the message “BRONCHOSPASM IS PRESENT”.

Additionally, if bronchospasm is present then the following rules mayalso be applied:

3) If:

-   -   a) the value of CAP-FEV1 is less than 80%;

then

-   -   display 566 shows the message “MODERATE BRONCHOSPASM IS        PRESENT”.

4) If:

-   -   a) the value of CAP-FEV1 is less than 80%;    -   b) the value of SPO₂ is less than 91% SAT; and    -   c) the value of ETCO₂ is less than 45 mm Hg;

then,

-   -   display 566 shows the message “SEVERE BRONCHOSPASM PRESENT”.

Thereafter a cycle of alternating I) sampling step (data collection andmeasurement) and II) diagnostic rule application to the previous samplestep I) is initiated:

I) Sampling Step

a) A sample of expired air is taken and conveyed from cannula 550 tocapnograph 552.

b) The carbon dioxide concentration is measured continuously bycapnograph 552 as capnogram 567.

c) The capnogram is digitized as waveform and store for analysis bycomputer 564.

d) Computer 564 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The slope and the run are determined by computer 564.

II) Diagnostic Rule Application Step

In a diagnostic rule application step, the following diagnostic rulesare preferably applied to the measured parameters of I) Sampling step bycomputer 564:

1) If:

-   -   a) the blood pressure values are within the normal range;    -   b) the respiratory rate is normal;    -   c) CO₂ run is less than or equal to 0.3 sec;    -   d) CO₂ slope is more than or equal to 100 mm Hg/sec;    -   e) SPO₂ is greater than or equal to 95% SAT; and    -   f) ETCO₂ is less than or equal to 45 mm Hg;

then,

-   -   display 566 shows the message “NO BRONCHOSPASM PRESENT.”

2) In contrast, if:

-   -   a) CO₂ run is greater than 0.3 sec;    -   b) CO₂ slope is less than 100 mm Hg/sec;    -   c) SPO₂ is more than or equal to 91% SAT, but less than 95% SAT;        and    -   d) ETCO₂ is less than 45 mm Hg;

then,

-   -   the message “MODERATE BRONCHOSPASM PRESENT” is displayed on        display 566.

3) If the parameters measured are yet further removed from theacceptable range, such as if:

-   -   a) CAP-FEV1 is less than 50%;    -   b) SPO₂ is less than 91% SAT; and    -   c) ETCO₂ is greater than 45 mm Hg;

then,

-   -   a message such as “SEVERE BRONCHOSPASM PRESENT” is displayed on        display 566.

At any one of the diagnostic rule application steps, it may be verifiedthat the patient is suffering from bronchospasm. Once bronchospasm isverified, the operator switches capnograph 552 to a serial comparisonmode. The medical team applies the appropriate interventions to thepatient to treat the bronchospasm.

Reference is now made to FIG. 35, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology operative in a hospital or EMS environment for diagnosingand treating respiratory failure. As seen in FIG. 35, various patientphysiologic activities are sensed and measured, including respiratoryphysiologic activities, preferably via an oral airway adapter and/or anasal or nasal/oral cannula 570, such as a Model Nasal FilterLine AdultXS 04461, O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 572, suchas, a Microcap, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 574, a fingersensor 576, a forehead/scalp sensor 578 and a blood pressure cuff 580respectively, may also be sensed and measured by suitableinstrumentation 582.

Following intubation of the patient and prior to securing the tube, theoutputs of the capnograph 572 and possibly of additional instrumentation582 are preferably supplied to a suitably programmed automaticdiagnostic and treatment computer 584, having an associated display 586which typically analyzes the respiration parameter output of thecapnograph 572 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement indicating properintubation, here “TUBE IN TRACHEA”.

The system determines whether characteristics of the capnograph waveformamplitude are normal. If the CO₂ levels as indicated by the capnographwaveform amplitude are below normal a diagnostic statement indicatingright mainstem bronchus intubation is presented, here “ABNORMALWAVEFORM, CHECK FOR RIGHT MAINSTEM BRONCHUS INTUBATION”.

Following repositioning of the tube, the system provides a patientstatus statement, here “WAVEFORM NORMALIZED, TUBE IN TRACHEA.

Reference is now made additionally to FIG. 36, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 35.

The patient in an ambulance, preferably attached to a multi-parametermonitor including capnograph 572, is monitored continuously for at least30 seconds. Expired air is collected via cannula 570 and is conveyed tothe capnograph 572.

Values of the CO₂ concentration is continuously measured, typically overa period of 30 seconds, and carbon dioxide waveforms are preferablydigitized as a capnogram and together with other waveforms are stored oncomputer 584.

The onset and offset limits of the patient'S capnogram from capnograph572 are delineated by computer 584.

The waveform quality of the capnogram 587 is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 1 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

If the quality is unacceptable, further samples are collected until asample of acceptable quality, according to the above two criteria, istaken.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 572. The slope and run values of the capnogramfrom capnograph 572 are determined by computer 584.

At startup, the following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a display is provided by computer 584 stating “GOOD WAVEFORM,        TUBE IN TRACHEA”.

In a checking step, repeated checks for abnormal waveform shape ofcapnogram 587. The following rules are preferably applied to thecapnogram shape:

1) If:

-   -   a) an abnormal waveform shape is observed;

then,

-   -   computer 584 displays “TUBE IMPROPERLY POSITIONED: CHECK FOR        RIGHT MAINSTEM INTUBATION” on display 586.

2) If:

-   -   a) a normal waveform shape is observed;

then,

-   -   computer 584 displays “TUBE PROPERLY POSITIONED: CONFIRM BREATH        SOUNDS AND SECURE TUBE” on display 586.

When tube is secure as is confirmed by an operator, the operatortypically inputs a code into computer 584 to activate an intubationmonitoring mode in capnograph 572. The capnogram is monitoredcontinuously for loss of signal. Loss of signal from capnograph 572 isindicative of the tube having slipped away from the trachea. As long asthere is a regular signal, computer 584 displays “MONITORING INTUBATION”on display 586.

Reference is now made to FIG. 37, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology operative in a hospital environment for diagnosing andtreating pulmonary embolism. As seen in FIG. 37, various patientphysiologic activities are sensed and measured, including respiratoryphysiologic activities, preferably via an oral airway adapter and/or anasal or nasal/oral cannula 600, such as a Model Nasal FilterLine AdultXS 04461; O₂/CO₂Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 602, suchas a Microcap, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 604, a fingersensor 606, a forehead/scalp sensor 608 and a blood pressure cuff 610respectively, may also be sensed and measured by suitableinstrumentation 612.

The outputs of the capnograph 602 and possibly of additionalinstrumentation 612 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 614, having an associateddisplay 616 which typically analyzes the respiration parameter output ofthe capnograph 602 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement alerting hospital staffto the possible presence of pulmonary embolism. A typical such statementis “ALERT: ABNORMAL WAVEFORM CONSISTENT WITH PULMONARY EMBOLISM”.Following intravenous medication for dissolving blood clots in thelungs, the system determines whether characteristics of the CO2 waveformamplitude and shape are approaching normal and preferably provides apatient status statement, here “WAVEFORM NORMALIZING, GOOD RESPONSE TOTREATMENT”.

Reference is now made additionally to FIG. 38, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 37.

The patient, preferably attached to a multi-parameter monitor includingcapnograph 602 and instrumentation 612, by means of cannula 600 andpreferably also by means of chest electrodes 604, finger sensor 606,scalp/forehead sensor 608 and blood pressure cuff 610, is monitoredcontinuously. The neurological status of the patient is acquired by anysuitable technique. Values of CO₂ concentration, ECG, NIBP and SPO₂ arecontinuously measured, typically over a period of 30 seconds, and carbondioxide waveforms are preferably digitized as a capnogram 617 and otherwaveforms and stored by computer 614.

Thereafter, the onset and offset limits of the capnogram, the pulsewaveform and QRS onset and offset are determined by computer 614. Theheart rate, blood pressure ETCO₂ and SPO₂ values are measured. Theinitial slope of the capnogram and the run, monitored by capnograph 602,are calculated by computer 614. Additionally, neurological findings,monitored by means of an EEG are inputted to computer 614.

At various intervals, the differences between consecutive measurementsof the various patient parameters are evaluated by computer 614. Aftereach treatment, in a diagnostic rule application step, the followingdiagnostic rule is preferably applied to the measured parameters bycomputer 614:

1) If:

-   -   a) the heart rate is greater than 100/min;    -   b) the SPO₂ is less than 90% SAT;    -   c) the ETCO₂ is less than 35 mm Hg;    -   d) the amplitude (area under curve) of the CO₂ waveform is less        than a predetermined value:    -   e) the ECG is normal; and    -   f) the respiratory rate is greater than 15/min;

display 616 shows the message “ALERT: VITAL SIGNS CONSISTENT WITH ACUTEPULMONARY EMBOLISM”.

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 614: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 614.

1) If:

-   -   a) the decrease in the SPO₂ values is greater than −5% SAT; or    -   b) the difference in the ETCO₂ slope is greater than +5 mm Hg;

then,

-   -   computer 614 displays on display 616 “PATIENT STATUS:        DETERIORATING”.

2) If:

-   -   a) the increase in the SPO₂ values is greater than +5% SAT; or    -   b) the difference in the ETCO₂ slope is more than −5 mm Hg;

then,

-   -   computer 614 displays on display 616 “PATIENT STATUS:IMPROVING”.

3) If:

-   -   a) the difference in the SPO₂ values is more positive than or        equal to −5% SAT, but less than or equal to +5%; or    -   b) the difference in the ETCO₂ slope greater than or equal to −5        mm Hg, but less than or equal to +5 mm Hg;

then,

-   -   computer 614 displays on display 616 “PATIENT STATUS:UNCHANGED”.

Following the monitoring stage, the following exit rules are preferablyapplied to the measured parameters of the patient by computer 232:

1) If:

-   -   a) the ECG values are within normal limits;    -   b) the respiratory rate is within normal limits;    -   c) the heart rate is within normal limits;    -   d) the SPO₂ value is greater than 95% SAT; and    -   e) the ETCO₂ value is less than 45 mm Hg;

then,

-   -   Computer 614 preferably displays on display 616 “VITAL SIGNS        STABLE”.

(If the patient's record complies with this exit rule, then a copy ofthe patient's record is handed off from computer 616 to the receivingcenter, for example, in the form of a chart. Typically, the receivingcenter stores this chart, so that it may be used as a baseline forcontinued monitoring of the patient).

Reference is now made to FIGS. 39A and 39B, which are simplifiedpictorial illustrations of an automatic medical diagnostic and treatmentsystem and methodology operative in a hospital environment fordetermining correct placement of a nasogastric tube in a patient. Asseen in FIGS. 39A and 39B, following insertion of a nasogastric tube ina patient, various patient physiologic activities are sensed andmeasured, including respiratory physiologic activities, preferably viaan oral airway adapter and/or a nasal or nasal/oral cannula 630, such asa Model Nasal FilterLine Adult XS 04461, O₂/CO₂ Nasal FilterLine Adult007141, or Smart CapnoLine Adult (Oral/nasal FilterLine) 007414,commercially available from Oridion Ltd., of Jerusalem Israel, typicallycoupled with a capnograph 632, such as a Microcap, commerciallyavailable from Oridion Ltd., of Jerusalem Israel. Other patientphysiologic activities relating to cardiac function (e.g. ECG), systemicoxygenation (e.g. pulse oximetry), cerebral oxygenation (e.g. cerebraloximetry) and systemic circulation (e.g. NIBP), typically sensed bymeans of chest electrodes 634, a finger sensor 636, a forehead/scalpsensor 638 and a blood pressure cuff 640 respectively, may also besensed and measured by suitable instrumentation 642.

The outputs of the capnograph 632 and possibly of additionalinstrumentation 642 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 644, having an associateddisplay 646 which typically analyzes the respiration parameter output ofthe capnograph 632 and possibly other parameters and provides an outputwhich preferably contains a status statement alerting hospital staff tothe possible misplacement of the nasogastric tube. A typical suchstatement “NASOGASTRIC (NG) TUBE IN LUNG”. This status statement ispreferably accompanied by a treatment recommendation; here “REPOSITIONNASOGASTRIC TUBE”. Following repositioning of the nasogastric tube, astatus statement confirming proper placement is preferably provided,here “NASOGASTRIC TUBE IN STOMACH”. This statement is preferablyaccompanied by a treatment recommendation, here “SECURE TUBE”.

Reference is now made additionally to FIG. 40, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIGS. 39A and 39B.

The patient, preferably attached to a multi-parameter monitor includingcapnograph 632, is monitored continuously for at least 30 seconds.Expired air is collected via cannula 630 and is conveyed to thecapnograph 632.

Values of the CO₂ concentration is continuously measured, typically overa period of 30 seconds, and carbon dioxide waveforms are preferablydigitized as a capnogram 647 and, together with other waveforms, isstored on computer 644.

The onset and offset limits of the patient's capnogram from capnograph632 are delineated by computer 644.

The waveform quality of the capnogram 647 is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 1 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

If the quality is unacceptable, further samples are collected until asample of acceptable quality, according to the above two criteria, istaken.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 632. The slope and run values of the capnogramfrom capnograph 632 are determined by computer 644.

The following checking rules are preferably applied.

1) If:

-   -   a) the ETCO₂ value is less than or equal to 15 mm Hg; or    -   b) there is a loss of the waveform of capnogram 647; then,    -   a display is provided by computer 644 stating “NO WAVEFORM        PRESENT, NG TUBE NOT IN TRACHEA”.

2) If:

-   -   a) the ETCO₂ value is more than or equal to 15 mm Hg; or    -   b) profile of exhaled gas is detected as a waveform of capnogram        647;

then,

-   -   a display is provided by computer 644 stating “CO₂ DETECTED, NG        TUBE IN TRACHEA.”

Reference is now made to FIG. 41, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology operative in a hospital environment for determining thepresence of acute myocardial infarction in a patient. As seen in FIG.41, following a patient complaint of chest pains, various patientphysiologic activities are sensed and measured, including respiratoryphysiologic activities, preferably via an oral airway adapter and/or anasal or nasal/oral cannula 650, such as a Model Nasal FilterLine AdultXS 04461, O₂/CO₂Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 652, suchas a Microcap, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 654, a fingersensor 656, a forehead/scalp sensor 658 and a blood pressure cuff 660respectively, may also be sensed and measured by suitableinstrumentation 662.

The outputs of the capnograph 652 and possibly of additionalinstrumentation 662 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 664, having an associateddisplay 666 which typically analyzes the respiration parameter output ofthe capnograph 652 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement alerting hospital staffto the possibility of occurrence of acute myocardial infarction. Atypical such statement is “VITAL SIGNS CONSISTENT WITH HEART ATTACK.CONDITION CRITICAL”. Following sublingual and/or intravenousadministration of a medicament such as nitroglycerin and morphine, apatient status statement is preferably provided, here “GOOD RESPONSE TOTREATMENT. CONDITION IMPROVING”.

Reference is now made additionally to FIG. 42, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 41.

The patient, preferably attached to a multi-parameter monitor includingcapnograph 652 and suitable instrumentation 662, by means of cannula 650and preferably also by means of chest electrodes 654, finger sensor 656,forehead/scalp sensor 658 and blood pressure cuff 660, is monitoredcontinuously. The neurological status of the patient is acquired by anysuitable technique. Values of CO₂ concentration, HR, BP (SYS/DIA) ECG,NIBP and SPO₂ are continuously measured, typically over a period of 30seconds, and carbon dioxide waveforms are preferably digitized as acapnogram 667 and other waveforms and stored on computer 664.

Thereafter, the onset and offset limits of the capnogram, the pulsewaveform and QRS onset and offset are determined by computer 664. Theinitial slope of the capnogram and the run are determined and stored incomputer 664.

At various intervals, the differences between consecutive measurementsof the various patient parameters are evaluated by computer 664. Aftereach treatment, in a diagnostic rule application step, the followingdiagnostic rules are preferably applied to the measured parameters bycomputer 664:

1) If:

-   -   a) there is a localized elevation in the ST segment in the ECG;        and    -   b) the ETCO₂ is declining at least by 2 mm Hg/min over five        minutes;

then,

-   -   display 666 shows the message “ACUTE MYOCARDIAL INFARCTION (MI)        SUSPECTED”.

2) If:

-   -   a) the SPO₂ value is less than 91% SAT; and    -   b) the ETCO₂ value is less than 30 mm Hg;

then,

-   -   display 66 shows the message “VITAL SIGNS CRITICAL”.

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 664: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 664.

1) If:

-   -   a) the difference in the ST elevation in the ECG is greater than        0.1 mm and    -   b) the difference in the ETCO₂ slope is less than −1 mm Hg/min;

then,

-   -   computer 664 displays on display 666 “PATIENT STATUS:        WORSENING”.

2) If:

-   -   a) the difference in the ST elevation in the ECG is less than        −0.1 mm and    -   b) the difference in the ETCO₂ is more than 1 mm Hg/min;

then,

-   -   computer 664 displays on display 666 “PATIENT STATUS:        IMPROVING”.

3) If:

-   -   a) the difference in the ST elevation in the ECG is more than or        equal to −0.1 mm but less than or equal to 0.1 mm; or    -   b) the difference in the ETCO₂ is more than or equal to −1 mm        Hg/min and is less than or equal to 1 mm Hg/min;

then,

-   -   computer 664 displays on display 666 “PATIENT STATUS:        UNCHANGED”.

Reference is now made to FIG. 43, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology operative in a hospital environment for determining thepresence of cardiogenic shock in a patient. As seen in FIG. 43, variouspatient physiologic activities are sensed and measured, includingrespiratory physiologic activities, preferably via an oral airwayadapter and/or a nasal or nasal/oral cannula 670, such as a Model NasalFilterLine Adult XS 04461, O₂/CO₂Nasal FilterLine Adult 007141, or SmartCapnoLine Adult (Oral/nasal FilterLine) 007414, commercially availablefrom Oridion Ltd., of Jerusalem Israel, typically coupled with acapnograph 672, such as a Microcap, commercially available from OridionLtd., of Jerusalem Israel. Other patient physiologic activities relatingto cardiac function (e.g. ECG), systemic oxygenation (e.g. pulseoximetry), cerebral oxygenation (e.g. cerebral oximetry) and systemiccirculation (e.g. NIBP), typically sensed by means of chest-electrodes674, a finger sensor 676, a forehead/scalp sensor 678 and a bloodpressure cuff 680 respectively, may also be sensed and measured bysuitable instrumentation 682.

The outputs of the capnograph 672 and possibly of additionalinstrumentation 682 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 684, having an associateddisplay 686 which typically analyzes the respiration parameter output ofthe capnograph 672 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement alerting hospital staffto the possibility of occurrence of cardiogenic shock. A typical suchstatement is “VITAL SIGNS CONSISTENT WITH CARDIOGENIC SHOCK. CONDITIONCRITICAL”. Following intravenous administration of a medicament such asdopamine dobutamine, a patient status statement is preferably provided,here “CONDITION IMPROVING”.

Reference is now made additionally to FIG. 44, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 43.

The patient, preferably attached to a multi-parameter monitor includingcapnograph 672 and suitable instrumentation 682, by means of cannula 670and preferably also by means of chest electrodes 674, finger sensor 676,forehead/scalp sensor 678 and blood pressure cuff 680, is monitoredcontinuously. The neurological status of the patient is acquired by anysuitable technique. Values of CO₂ concentration, HR, BP (SYS/DIA) ECG,NIBP and SPO₂ are continuously measured, typically over a period of 30seconds, and carbon dioxide waveforms are preferably digitized as acapnogram 667 and other waveforms and stored on computer 684.

Thereafter, the onset and offset limits of the capnogram, the pulsewaveform and QRS onset and offset are determined by computer 684. Theinitial slope of the capnogram and the run are determined and stored incomputer 684.

At various intervals, the differences between consecutive measurementsof the various patient parameters are evaluated by computer 684.

After each interval, in a diagnostic rule application step, thefollowing diagnostic rules are preferably applied to the measuredparameters by computer 684:

1) If:

-   -   a) the systolic blood pressure is less than 90 mm Hg;    -   b) the heart rate is more than 100/min;    -   c) the respiratory rate is more than 15/min; and    -   d) and the ETCO₂ is less than 35 mm Hg;

then,

-   -   display 686 shows the message “ALERT: CONSIDER CARDIOGENIC        SHOCK”.

2)

-   -   a) the SPO₂ value is less than 91% SAT; and    -   b) the ETCO₂ value is less than 30 mm Hg;

then,

-   -   display 686 shows the message “VITAL SIGNS CRITICAL”.

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 684: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 684.

1) If:

-   -   a) the difference in the systolic blood pressure is less than −5        mm Hg; and    -   b) the difference in the ETCO₂ is less than −1 mm Hg/min;

then,

-   -   computer 664 displays on display 666 “PATIENT STATUS:WORSENING”.

2) If:

-   -   a) the difference in the systolic blood pressure is more than 5        mm Hg; and    -   b) the difference in the ETCO₂ is more than 1 mm Hg/min;

then,

-   -   computer 664 displays on display 666 “PATIENT STATUS:IMPROVING”.

3) If:

-   -   a) the difference in the systolic blood pressure is more than or        equal to −5 mm Hg and less than or equal to +5 mm Hg; and/or    -   b) the difference in the ETCO₂ is more than or equal to −1 mm        Hg/min and is less than or equal to 1 mm Hg/min;

then,

-   -   computer 684 displays on display 686 “PATIENT STATUS:UNCHANGED”.

Reference is now made to FIG. 45, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology operative in a hospital environment for determining thepresence of cardiac arrest in a patient. As seen in FIG. 45, a patientwho is found to be unconscious and unresponsive is subsequentlyconnected to the system of the present invention. Various patientphysiologic activities are sensed and measured, including respiratoryphysiologic activities, preferably via an oral airway adapter and/or anasal or nasal/oral cannula 700, such as a Model Nasal FilterLine AdultXS 04461, O₂/CO₂ Nasal FilterLine Adult 007141, or Smart CapnoLine Adult(Oral/nasal FilterLine) 007414, commercially available from OridionLtd., of Jerusalem Israel, typically coupled with a capnograph 702, suchas a Microcap, commercially available from Oridion Ltd., of JerusalemIsrael. Other patient physiologic activities relating to cardiacfunction (e.g. ECG), systemic oxygenation (e.g. pulse oximetry),cerebral oxygenation (e.g. cerebral oximetry) and systemic circulation(e.g. NIBP), typically sensed by means of chest electrodes 704, a fingersensor 706, a forehead/scalp sensor 708 and a blood pressure cuff 710respectively, may also be sensed and measured by suitableinstrumentation 712.

The outputs of the capnograph 702 and possibly of additionalinstrumentation 712 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 714, having an associateddisplay 716 which typically analyzes the respiration parameter output ofthe capnograph 702 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement alerting hospital staffto the possibility of occurrence of cardiac arrest. A typical suchstatement is “ALERT: CARDIAC ARREST”. Following treatment, typicallyincluding intubation and intravenous administration of a medicament suchas adrenaline, during external cardiac massage, a patient statusstatement, indicating the effectiveness of the treatment is preferablyprovided, here “EFFECTIVE CARDIAC COMPRESSIONS:” The system alsopreferably diagnoses the return of spontaneous circulation and promptsthe caregiver to check for the presence of a pulse, here by means of adiagnostic statement and a treatment recommendation such as “RETURN OFSPONTANEOUS CIRCULATION. CHECK FOR PULSE”.

Reference is now made additionally to FIG. 46, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 45.

The patient, preferably attached to a multi-parameter monitor includingcapnograph 702 and suitable instrumentation 712, by means of cannula 700and preferably also by means of chest electrodes 704, finger sensor 706,forehead/scalp sensor 708 and blood pressure cuff 710, is monitoredcontinuously. The neurological status of the patient is acquired by anysuitable technique. Values of CO₂ concentration, HR, BP (SYS/DIA) ECG,NIBP and SPO₂ are continuously measured, typically over a period of 30seconds, and carbon dioxide waveforms are preferably digitized as acapnogram 717, and is stored on computer 714 together with otherwaveforms.

Thereafter, the onset and offset limits of the capnogram, the pulsewaveform and QRS onset and offset are determined by computer 714: Theinitial slope of the capnogram and the run are determined and stored incomputer 714.

At various intervals, the differences between consecutive measurementsof the various patient parameters are evaluated by computer 714.

After each time interval, the difference between consecutive measures ofeach parameter are calculated by computer 714: Thereafter, the followingmonitoring rules are preferably applied to the measured parameters bycomputer 714.

1) If:

-   -   a) the heart rate is less than 30/min; and    -   b) the ETCO₂ value is less than 15 mm Hg;

then,

-   -   computer 714 displays on display 716 “NO RETURN OF CIRCULATION”.

2) If:

-   -   a) the heart rate is more than or equal to 30/min; and    -   b) the ETCO₂ value is more than or equal to 15 mm Hg;

then,

-   -   computer 714 displays on display 716 “RETURN OF CIRCULATION”.

Reference is now made to FIG. 47, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology operative in a out of hospital environment for determiningthe presence of acute cardiac ischemia in a patient.

As seen in FIG. 47, while a patient, undergoes treadmill testing in adoctor's office, various patient physiologic activities are sensed andmeasured, including respiratory physiologic activities, preferably viaan oral airway adapter and/or a nasal or nasal/oral cannula 730, such asa Model Nasal FilterLine Adult XS 04461, O₂/CO₂Nasal FilterLine Adult007141, or Smart CapnoLine Adult (Oral/nasal FilterLine) 007414,commercially available from Oridion Ltd., of Jerusalem Israel, typicallycoupled with a capnograph 732, such as a Microcap, commerciallyavailable from Oridion Ltd., of Jerusalem Israel. Other patientphysiologic activities relating to cardiac function (e.g. ECG), systemicoxygenation (e.g. pulse oximetry), cerebral oxygenation (e.g. cerebraloximetry) and systemic circulation (e.g. NIBP), typically sensed bymeans of chest electrodes 734, a finger sensor 736, a forehead/scalpsensor 738 and a blood pressure cuff 740 respectively, may also besensed and measured by suitable instrumentation 742.

The outputs of the capnograph 732 and possibly of additionalinstrumentation 742 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 744, having an associateddisplay 746 which typically analyzes the respiration parameter output ofthe capnograph 732 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement, here “VITAL SIGNSNORMAL”, which indicates normal patient condition. At some pointthereafter, a further diagnostic statement appears, here, “ALERT: ACUTECARDIAC ISCHEMIA”. Upon noticing this statement, the physician causesthe patient to lie down and administers oxygen treatment to the patient.The system assesses the patient's response to the treatment and providesa patient status message, here “VITAL SIGNS NORMAL”.

Reference is now made additionally to FIG. 48, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 47.

The patient, preferably attached to a multi-parameter monitor includingcapnograph 732 and suitable instrumentation 742, by means of cannula 730and preferably also by means of chest electrodes 734, finger sensor 736,forehead/scalp sensor 738 and blood pressure cuff 740, is monitoredcontinuously. The neurological status of the patient is acquired by anysuitable technique. Values of CO₂ concentration, HR, BP (SYS/DIA) ECG,NIBP and SPO₂ are continuously measured, typically over a period of 30seconds, and carbon dioxide waveforms are preferably digitized as acapnogram 747, and is stored on computer 744 together with otherwaveforms.

Thereafter, the onset and offset limits of the capnogram, the pulsewaveform and QRS onset and offset are determined by computer 744. Theinitial slope of the capnogram and the run are determined and stored incomputer 744.

In the next step, when the monitoring has been verified by the operator,that it is functioning correctly, the baseline cardiorespiratory patternis stored in computer 744.

Thereafter, computer 744 and/or the operator activates capnograph 732 ina monitoring mode. The patient is monitored continuously by capnograph732 for any significant change in the cardiorespiratory pattern.

The following monitoring rule is preferably applied to capnogram 747 bycomputer 744.

1) If:

-   -   a) a significant change in the cardiorespiratory pattern is        apparent;

then,

-   -   computer 744 displays “MONITORING STRESS RESPONSE” on display        746.

Thereafter, a cycle of alternating I) sampling step (data collection andmeasurement) and II) diagnostic rule application to the previous samplestep I) is initiated.

I) Sampling step

a) A sample of expired air is taken and conveyed from cannula 400 tocapnograph 732.

b) The carbon dioxide concentration is measured continuously bycapnograph 744 as a capnogram 747.

c) The capnogram is digitized as waveform and store for analysis bycomputer 744.

d) Computer 744 marks onset and offset limits of the capnogram.

e) The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

f) The Slope and the run are determined by computer 744.

II) Diagnostic Rule Application Step

In a diagnostic rule application step, the following diagnostic rulesare preferably applied to the measured parameters of each sample in I)Sampling step by computer 744:

1) If:

-   -   a) there are no signs of ischemia (no elevation from baseline in        the ECG ST segment; and no changes from baseline in the T-waves;    -   b) there are no changes towards ischemia (rising ST-segment        values on ECG from baseline, and dropping ETCO₂ values >5 mm Hg        from baseline);

then,

-   -   Computer 744 displays on display 746 “NO SIGNS OF ACUTE CARDIAC        ISCHEMIA”.

2) If:

-   -   a) a) there are signs of ischemia; or    -   b) there are changes towards ischemia; then,    -   Computer 744 displays on display 746 “ALERT: SIGNS OF ACUTE        CARDIAC ISCHEMIA”.

Reference is now made to FIG. 49, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology operative in a hospital or outpatient environment forsedation and/or anesthesia monitoring. As seen in FIG. 49, while apatient is under sedation and/or anesthesia, typically in the course ofa medical procedure, various patient physiologic activities are sensedand measured, including respiratory physiologic activities, preferablyvia an oral airway adapter and/or a nasal or nasal/oral cannula 800,such as a Model Nasal FilterLine Adult XS, 04461, O₂/CO₂ NasalFilterLine Adult 007141, or Smart CapnoLine Adult (Oral/nasalFilterLine) 007414, commercially available from Oridion Ltd., ofJerusalem Israel, typically coupled with a capnograph 802, such as aMicrocap, commercially available from Oridion Ltd., of Jerusalem Israel.Other patient physiologic activities relating to cardiac function (e.g.ECG), systemic oxygenation (e.g. pulse oximetry), cerebral oxygenation(e.g. cerebral oximetry) and systemic circulation (e.g. NIBP), typicallysensed by means of chest electrodes 804, a finger sensor 806, aforehead/scalp sensor 808 and a blood pressure cuff 810 respectively,may also be sensed and measured by suitable instrumentation 812.

The outputs of the capnograph 802 and possibly of additionalinstrumentation 812 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 814, having an associateddisplay 816 which typically analyzes the respiration parameter output ofthe capnograph 802 and possibly other parameters and provides an outputwhich preferably contains a diagnostic statement confirming properrespiration, here “NORMAL WAVEFORM RHYTHM”.

If at a later stage during the medical procedure, a deviation from thepatient's normal CO2 waveform rhythm is sensed, a further diagnosticstatement is provided, here “ALERT: SIGNIFICANT DEVIATION IN WAVEFORMRHYTHM”. This statement is preferably accompanied by a treatmentrecommendation, here “REDUCE SEDATION LEVEL”. Following reduction in thesedation level, a diagnostic statement which indicates the patientstatus is preferably presented, here “NORMAL WAVEFORM RHYTHM RESTORED”.

Reference is now made additionally to FIG. 50, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 49.

The patient, preferably attached to a multi-parameter monitor includingcapnograph 802, is typically monitored continuously for at least 30seconds. Additionally or alternatively, the patient may be monitored forshorter or longer durations. Expired air is collected via cannula 800and is conveyed to the capnograph 802.

Values of the CO₂ concentration are continuously measured, typicallyover a period of 30 seconds, and carbon dioxide waveforms are preferablydigitized as a capnogram 817 and, together with other waveforms, isstored on computer 814.

The onset and offset limits of the patient's capnogram from capnograph802 are delineated by computer 814.

The waveform quality of the capnogram 817 is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 1 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

If the quality is unacceptable, further samples are collected until asample of acceptable quality, according to the above two criteria, istaken.

The next step entails a checking procedure, wherein the ETCO₂ value ismeasured by capnograph 632. The slope and run values of the capnogramfrom capnograph 632 are determined by computer 644.

The following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a display is provided by computer 814 stating “NORMAL WAVEFORM        RHYTHM”.

After the waveform rhythm has been confirmed by an operator, thecapnograph is entered into its monitoring mode, either by the operatoror by computer 814. Capnograph 802 then monitors for any changes in thebreathing pattern of the patient.

Thereafter, computer 814 displays “MONITORING SEDATION” on display 646.

The next step entails a cycle of alternating I) sampling step (datacollection and measurement) and II) diagnostic rule application to theprevious sample step I) is initiated.

I) Sampling Step

In this sampling step, an exhaled air sample from cannula 800 isperiodically collected, conveyed and measured by capnograph 802. Thecarbon dioxide concentration value is determined continuously bycapnograph 802. Computer 814 digitizes the capnograph signals as awaveform and store the waveform for analysis.

Thereafter, the ETCO₂ value is determined.

II) Diagnostic Rule Application Step.

The following diagnostic rules are applied to each sample:

1) If:

-   -   a) The value of ETCO₂ is greater than or equal to 15 mm Hg; and    -   b) There is no loss in the waveform from capnograph 802; and    -   c) The respiratory rate is greater than or equal to 12/min;

then,

-   -   computer 814 displays “NORMAL VENTILATORY WAVEFORM AND RHYTHM”        on display 816.

2) If:

-   -   a) The value of ETCO₂ is less than 15 mm Hg; or    -   b) There is a loss in the waveform from capnograph 802; or    -   c) The respiratory rate is less than 10/min; or    -   d) There is a decline in ETCO₂ of 50%; or    -   e) There is a 50% increase in the pattern variability; or    -   f) There is a 50% decrease in the pattern similarity;

then,

-   -   computer 814 displays “ALERT: DIMINISHED VENTILATORY WAVEFORM”        on display 816.

This cycle typically proceeds until the patient monitoring is halted bythe medical team or operator.

Reference is now made to FIG. 51, which is a simplified pictorialillustration of an automatic medical diagnostic and treatment system andmethodology operative in a hospital or outpatient environment forsedation and/or anesthesia titration. As seen in FIG. 51, when a patientis being sedated prior to carrying out of a medical procedure, variouspatient physiologic activities are sensed and measured, includingrespiratory physiologic activities, preferably via an oral airwayadapter and/or a nasal or nasal/oral cannula 900, such as a Model NasalFilterLine Adult XS 04461, O₂/CO₂Nasal FilterLine Adult 007141, or SmartCapnoLine Adult (Oral/nasal FilterLine) 007414, commercially availablefrom Oridion Ltd., of Jerusalem Israel, typically coupled with acapnograph 902, such as a Microcap, commercially available from OridionLtd., of Jerusalem Israel. Other patient physiologic activities relatingto cardiac function (e.g. ECG), systemic oxygenation (e.g. pulseoximetry), cerebral oxygenation (e.g. cerebral oximetry) and systemiccirculation (e.g. NIBP), typically sensed by means of chest electrodes904, a finger sensor 906, a forehead/scalp sensor 908 and a bloodpressure cuff 910 respectively, may also be sensed and measured bysuitable instrumentation 912.

The outputs of the capnograph 902 and possibly of additionalinstrumentation 912 are preferably supplied to a suitably programmedautomatic diagnostic and treatment computer 914, having an associateddisplay 916 which typically analyzes the respiration parameter output ofthe capnograph 902 and possibly other parameters and provides an outputwhich preferably contains a patient status statement confirming properrespiration, here “NORMAL RESPIRATORY PATTERN”.

If, following the administration of additional medication, a deviationfrom the patient's normal CO2 waveform shape, amplitude or periodicityis sensed, a further status statement is provided, here “ALERT: MILDHYPOVENTILATION PRESENT”. Following the administration of additionalmedication which increases the sedation level, an additional diagnosticstatement which indicates the patient status is preferably presented,here “ALERT MODERATE HYPOVENTILATION PRESENT”. This alert indicates thatat this point, titration of medication is complete and the medicalprocedure may be commenced. Following completion of the medicalprocedure, monitoring continues until a further status statement, here“NORMAL RESPIRATORY PATTERN RESTORED” indicates normal respiration andthat the patient may be safely discharged.

Reference is now made additionally to FIG. 52, which illustrates theoperation of the system and methodology of the system of the presentinvention in the context of FIG. 51.

The patient, preferably attached to a multi-parameter monitor includingcapnograph 902, is monitored continuously for at least 30 seconds.Expired air is collected via cannula 900 and is conveyed to thecapnograph 902.

Values of the CO₂ concentration is continuously measured, typically overa period of 30 seconds, and carbon dioxide waveforms are preferablydigitized as a capnogram 917 and, together with other waveforms, isstored on computer 914.

The onset and offset limits of the patient's capnogram from capnograph902 are delineated by computer 914.

The waveform quality of the capnogram 917 is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

If the quality is unacceptable, further samples are collected until asample of acceptable quality, according to the above two criteria, istaken.

Thereafter, the ETCO₂ value and the respiratory rate are determined.

At startup a checking procedure is performed, wherein the ETCO₂ value ismeasured by capnograph 902. The slope and run values of the capnogramfrom capnograph 902 are determined by computer 914.

The following checking rule is preferably applied.

1) If:

-   -   a) the ETCO₂ value is more than 15 mm Hg;

then,

-   -   a display is provided by computer 914 stating “GOOD WAVEFORM        QUALITY; MONITORING LEVEL OF SEDATION.

After the waveform rhythm has been confirmed by an operator; thebaseline breathing pattern is stored in computer 914. Capnograph 902 isentered into its monitoring mode, either by the operator or by computer914. Capnograph 902 then monitors for any changes in the breathingpattern of the patient.

The next step entails a cycle of alternating I) sampling step (datacollection and measurement) twice per minute and II) diagnostic ruleapplication to the previous sample step I) is initiated.

I) Sampling Step

In this sampling step, an exhaled air sample from cannula 900 isperiodically collected, conveyed and measured by capnograph 902. Thecarbon dioxide concentration value is determined continuously bycapnograph 902. Computer 914 digitizes the capnograph signals as awaveform and computer 914 stores the waveform for analysis. Computer 914marks onset and offset limits of the capnogram.

The waveform quality of the capnogram is assessed by employing thecriteria that an acceptable quality is defined by:

-   -   i) the root mean square (rms) of the noise of the waveform must        be less than 2 mm Hg; and    -   ii) the breath-to-breath correlation must be greater than 0.85.

Thereafter ETCO₂ and the respiratory rate are measured, and the resultsstored on computer 914.

II) Diagnostic Rule Application Step.

The following diagnostic rules are applied to each sample:

1) If:

-   -   a) The value of ETCO₂ is greater than or equal to 15 mm Hg, but        less than 50 mm Hg;    -   b) There is no loss in the waveform from capnograph 902; and    -   c) The respiratory rate is greater than 12/min;

then,

-   -   computer 914 displays “NORMAL RESPIRATORY PATTERN” on display        916.

2) If:

-   -   a) The respiratory rate is more than or equal to 10/min, but        less than 12/min;

then,

-   -   computer 914 displays “MILD HYPOVENTILATION” on display 916.

3) If:

-   -   a) The value of ETCO₂ is greater than or equal to 50 mm Hg, but        less than 60 mm Hg; and    -   b) The respiratory rate is more than or equal to 6/min, but less        than 10/min;

then,

-   -   computer 914 displays “MODERATE HYPOVENTILATION” on display 916.

4) If:

-   -   a) The value of ETCO₂ is greater or equal to 60 mm Hg; or    -   b) There is a loss in the waveform; or    -   c) The respiratory rate is less than 6/min;

then,

-   -   computer 914 displays “ALERT: SEVERE HYPOVENTILATION OR APNEA”        on display 916.

It should be understood that the rules, such as monitoring anddiagnostic rules exemplified hereinabove are not meant to be limitingonly to those and the numerical values therein that have been shownherein, and that these rules could be applied using to similar ordifferent numerical values and could incorporate further rules appliedto other parameters. The rules provided herein may be provided ascontinuous or discontinuous rules, and may additionally or alternativelybe applied in other combinations of continuity or discontinuity.Furthermore, it should be understood that the term “time interval” mayinclude the time required for a treatment to be effective in a patient,and the word “treatment” may also be used to denote the time requiredfor the treatment to be effective, such as in the phrase “after eachtreatment”.

It will be appreciated by persons skilled in the art that the presentinvention is not limited by what has been particularly shown anddescribed hereinabove. Rather the scope of the present inventionincludes both combinations and subcombinations of the features describedhereinabove as well as modifications and variations thereof which wouldoccur to a person of skill in the art upon reading the foregoingdescription and which are not in the prior art.

The invention claimed is:
 1. A method for determining a condition of apatient, the method comprising: receiving, at a processor, a CO₂waveform indicative of partial-pressure CO₂ values of the patient,wherein the CO₂ waveform is obtained by a capnograph coupled to anelement positioned within an airway of the patient; receiving, at theprocessor, a signal indicative of a cardiac function of the patient,wherein the signal is obtained by electrodes positioned on a chest ofthe patient; using the processor: computing at least one parameterrelating to the CO₂ waveform, wherein the at least one parameterrelating to the CO₂ waveform comprises a slope, an angle of rise, a timeto rise, a run time of the rise, or any combination thereof; computingat least one additional parameter relating to the signal indicative ofthe cardiac function; identifying and storing a baselinecardiorespiratory pattern of the patient based on the at least oneparameter relating to the CO₂ waveform and the at least one additionalparameter relating to the signal indicative of the cardiac function;activating a monitoring mode in response to a change in the baselinecardiorespiratory pattern, wherein the monitoring mode comprises adiagnostic protocol, wherein, in the diagnostic protocol, the processor:determines a respective change in the at least one parameter relating tothe CO₂ waveform, a respective change in the at least one additionalparameter relating to the signal indicative of cardiac function, orboth; and determines the condition of the patient based on therespective change in the at least one parameter relating to the CO₂waveform, the respective change in at least one additional parameterrelating to the signal indicative of cardiac function, or both; andprovides an instruction to a display to provide an alert indicative ofthe condition of the patient.
 2. The method of claim 1, wherein theadditional parameter comprises a ST-segment value, a T-wave, a QRScomplex, or any combination thereof.
 3. The method of claim 2,comprising determining that the condition of the patient is an abnormalcardiac condition in response to identifying an increase in theST-segment value and a decrease in an end-tidal CO₂ (EtCO₂) valuerelative to respective baseline values.
 4. The method of claim 1,wherein the monitoring mode comprises a sampling protocol in which theCO₂ waveform and the signal indicative of the cardiac function of thepatient are obtained, and the method comprises alternating between thesampling protocol and the diagnostic protocol.
 5. The method of claim 4,comprising determining a waveform quality of the CO₂ waveform while inthe sampling protocol, wherein the waveform quality is based on abreath-to-breath correlation and a root mean square value of noise ofthe CO₂ waveform.
 6. The method of claim 1, wherein the alert indicatesthe presence of acute cardiac ischemia.
 7. The method of claim 1,wherein the alert indicates the absence of acute cardiac ischemia. 8.The method of claim 1, comprising receiving, at the processor, one ormore additional signals from one or more additional sensing units,wherein the one or more additional sensing units comprises a pulseoximeter comprising a first sensor positioned on a finger of thepatient, a cerebral oximeter comprising a second sensor positioned on aforehead of the patient, an NIBP comprising a cuff positioned on an armof the patient, or any combination thereof.
 9. The method of claim 1,comprising providing another instruction to the display to provide asecond alert indicating that the monitoring mode is activated.
 10. Asystem configured to determine a cardiac condition of a patient,comprising: a processor configured to: receive, from a capnographcoupled to an element positioned within an airway of the patient, a CO₂waveform indicative of partial-pressure CO₂ values of the patient;receive, from electrodes positioned on a chest of the patient, a secondsignal indicative of cardiac function of the patient; compute at leastone parameter relating to the CO₂ waveform, wherein the at least oneparameter relating to the CO₂ waveform comprises a slope, an angle ofrise, a time to rise, a run time of the rise, or any combinationthereof; compute at least one additional parameter relating to thesignal indicative of the cardiac function; identify and store a baselinecardiorespiratory pattern of the patient based on the at least oneparameter relating to the CO₂ waveform and the at least one additionalparameter relating to the signal indicative of the cardiac function;activate a monitoring mode in response to identification of a change inthe baseline cardiorespiratory pattern, wherein the monitoring modecomprises a diagnostic protocol, wherein, in the diagnostic protocol,the processor is configured to: determine a respective change in the atleast one parameter relating to the CO₂ waveform, a respective change inthe at least one additional parameter relating to the signal indicativeof the cardiac function, or both; and determine the condition of thepatient based on the respective change in the at least one parameterrelating to the CO₂ waveform, the respective change in the at least oneadditional parameter relating to the signal indicative of the cardiacfunction, or both; and provide an instruction to a display to provide analert indicative of the condition of the patient.
 11. The system ofclaim 10, comprising the capnograph and the electrodes.
 12. The systemof claim 11, comprising one or more additional sensing units, whereinthe one or more additional sensing units comprises a pulse oximetercomprising a first sensor positioned on a finger of the patient, acerebral oximeter comprising a second sensor positioned on a forehead ofthe patient, an NIBP comprising a cuff positioned on an arm of thepatient, or any combination thereof.
 13. The system of claim 10, whereinthe processor is configured to provide an another instruction to thedisplay to provide a second alert that indicates the monitoring mode isactivated.
 14. A patient monitoring system, comprising: a capnographconfigured to measure at least one respiratory parameter relating to aCO₂ waveform, wherein the at least one respiratory parameter comprisesan end tidal CO₂ (EtCO₂) value; an electrocardiogram (ECG) configured tomeasure at least one cardiac parameter relating to cardiac function,wherein the at least one cardiac parameter comprises an ST-segmentvalue, a T-wave, or both; a processor configured to: receive the atleast one respiratory parameter and the at least one cardiac parameter;determine a baseline cardiorespiratory pattern based on the at least onerespiratory parameter and the at least one cardiac parameter; activate amonitoring mode in response to identification of the baselinecardiorespiratory pattern, wherein, in the monitoring mode, theprocessor is configured to: instruct the capnograph to continuouslymeasure the at least one respiratory parameter and instruct the ECG tocontinuously monitor the at least one the cardiac parameter; determineone or more changes to the at least one respiratory parameter, the atleast one cardiac parameter, or both; generate an alert indicative of acondition of the patient in response to the one or more changes in theat least one respiratory parameter, the at least one cardiac parameter,or both; and instruct a display to display the alert, the at least onerespiratory parameter, and the at least one cardiac parameter.
 15. Thepatient monitoring system of claim 14, wherein the alert is indicativeof a normal condition of the patient when the processor determines thatthe ST-segment value and the T-wave have not changed relative torespective baseline values.
 16. The patient monitoring system of claim14, wherein the alert is indicative of an abnormal condition when theprocessor detects an increase in the ST-segment value and a decrease inEtCO₂ relative to respective baseline values.
 17. The patient monitoringsystem of claim 16, wherein the abnormal condition is acute cardiacischemia.
 18. The patient monitoring system of claim 14, wherein themonitoring mode comprises a sampling protocol and a diagnostic protocol,and wherein the processor is configured to alternate between thesampling protocol and the diagnostic protocol to determine the conditionof the patient.
 19. The patient monitoring system of claim 14, whereinthe processor is configured to determine a waveform quality of the CO₂waveform while in the sampling protocol, and wherein the waveformquality is based on a breath-to-breath correlation and a root meansquare value of noise of the CO₂ waveform.
 20. The patient monitoringsystem of claim 14, comprising one or more additional sensing units,wherein the one or more additional sensing units comprises a pulseoximeter comprising a first sensor positioned on a finger of thepatient, a cerebral oximeter comprising a second sensor positioned on aforehead of the patient, an NIBP comprising a cuff positioned on an armof the patient, or any combination thereof.